Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Publishing type：Research paper (scientific journal)   Publisher：Frontiers Media SA  

Introduction: Several healthy euploid births have been reported following the transfer of mosaic embryos, including both euploid and aneuploid blastomeres. This has been attributed to a reduced number of aneuploid cells, as previously reported in mice, but remains poorly explored in humans. We hypothesized that mitochondrial function, one of the most critical factors for embryonic development, can influence human post-implantation embryonic development, including a decrease of aneuploid cells in mosaic embryos.

Methods: To clarify the role of mitochondrial function, we biopsied multiple parts of each human embryo and observed the remaining embryos under in vitro culture as a model of post-implantation development (n = 27 embryos). Karyotyping, whole mitochondrial DNA (mtDNA) sequencing, and mtDNA copy number assays were performed on all pre- and post-culture samples.

Results: The ratio of euploid embryos was significantly enhanced during in vitro culture, whereas the ratio of mosaic embryos was significantly reduced. Furthermore, post-culture euploid and culturable embryos had significantly few mtDNA mutations, although mtDNA copy numbers did not differ.

Discussion: Our results indicate that aneuploid cells decrease in human embryos post-implantation, and mtDNA mutations might induce low mitochondrial function and influence the development of post-implantation embryos with not only aneuploidy but also euploidy. Analyzing the whole mtDNA mutation number may be a novel method for selecting a better mosaic embryo for transfer.

DOI： 10.3389/fcell.2023.1215626

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s10147-023-02366-2

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Other Link： https://link.springer.com/article/10.1007/s10147-023-02366-2/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)  

With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.

DOI： 10.5534/wjmh.220102

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Introduction: Malignant bone and soft tissue tumors, commonly called sarcomas, predominantly originate in bone and soft tissues and typically affect individuals at a younger age. Following the resection of the primary tumor, treatment often necessitates radiation therapy and gonadotoxic chemotherapy, the specifics of which depend on the disease's stage Conversely, there is a notable concern regarding the potential loss of fertility due to these treatments. Consequently, it is recommended that men consider sperm cryopreservation before initiating treatment. This study aims to assess spermatogenesis in male patients diagnosed with malignant bone and soft tissue tumors before and after chemotherapy. Methods: This study involved 34 male patients diagnosed with malignant bone and soft tissue tumors and subsequently underwent sperm cryopreservation before initiating treatment. Medical records included details about the primary disease, age, marital status at presentation, semen analysis results, treatment regimen and number of courses, post-treatment semen analysis, renewal status and outcomes. Results: The mean age at the time of sperm cryopreservation was 22.8 years. The median semen volume was 2.5 mL, sperm concentration was 32.6 million/ml, and sperm motility was 38.5%. Following chemotherapy, semen analysis was conducted on 12 patients, with ifosfamide being the predominant drug used in all cases. Among these 12 patients, eight retained viable spermatozoa, and two successfully achieved spontaneous pregnancies resulting in live births. In one of the remaining four cases where no sperm were detected in ejaculate, a live birth was achieved through intracytoplasmic sperm injection using cryopreserved sperm. Discussion: While ifosfamide, the primary chemotherapy drug for patients with malignant bone and soft tissue tumors, was associated with severe impairments in spermatogenesis, recovery of spermatogenesis was observed in many cases. However, there were instances of prolonged azoospermia. Even in such cases, assisted reproduction using cryopreserved sperm remained viable for achieving parenthood. In light of these findings, offering patients the opportunity for fertility preservation is advisable.

DOI： 10.3389/fphar.2023.1324339

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Varicocelectomy is well known to improve the pregnancy outcome of patients with clinical varicoceles in assisted reproductive technologies as well as spontaneous conception. Therefore, this study aimed to evaluate the additional effects of oral antioxidant therapy after varicocelectomy on the pregnancy outcome in the assisted reproductive technology setting. METHODS: This study was a retrospective cohort study. The subjects were couples among whom the male partner had undergone varicocelectomy and was scheduled for subsequent assisted reproductive technology. Pregnancy outcomes were followed retrospectively in 62 couples with male partners who received tocopherol (antioxidant group) and 37 couples who did not (control group). The tocopherol and control groups were assigned dependent on the decision of the physician in charge and the patient's request. The clinical pregnancy rates per couple and embryo transfer, time to pregnancy, and the number of cycles during transfer to pregnancy were evaluated. RESULTS: No significant differences were observed in the pregnancy rate per couple (antioxidant group 70.9% vs. control group 64.9%, P = 0.55) and per embryo transfer (50.4% vs. 39.6%, P = 0.22). Regarding the time to event analyzed by adjusted restricted mean survival time, the mean time to pregnancy was significantly shorter in the antioxidant (tocopherol) group (14.2 vs. 17.4 months, P = 0.025). No significant difference was observed in the embryo transfer cycle to pregnancy (mean embryo transfer cycles: 2.6 vs. 3.0, P = 0.238). CONCLUSIONS: Additional oral tocopherol nicotinate as antioxidant therapy after varicocelectomy was shown to shorten the time to pregnancy. It is recommended that add-on effects be tested in more well-designed randomized controlled trials to examine whether it improves assisted reproductive outcomes.

DOI： 10.3389/frph.2023.1325566

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Purpose: Fertility preservation (FP) is becoming increasingly common among child, adolescent, and young-adult (CAYA) patients with cancer. However, Japan has long lacked definite estimates of utilization rates for FP services among CAYA patients with cancer, and little is known about disease/FP outcomes among users. Therefore, the Japan Society for Fertility Preservation (JSFP) launched the Japan Oncofertility Registry (JOFR) in 2018 and started the online registration of information regarding primary disease, FP, and data on prognosis and pregnancy outcomes. This study reports the analytical results of FP data registered in the JOFR as of 2021. Methods: Data about patients' primary disease(s), treatment courses, cancer and pregnancy outcomes, and specific procedures were extracted from the JOFR and analyzed. Results: In 2021, 1244 patients received counseling or treatment related to FP (540 males, 704 females). While the numbers of males in each age group were approximately equal, most females were aged between 31 and 40 years. In total, 490 male and 540 female patients underwent FP procedures. Leukemia, testicular cancer, and malignant lymphoma accounted for the majority of male cases seeking treatment, whereas breast cancer was the primary disease in two-thirds of the females. Since 1999, 395 patients have accumulatively experienced subsequent pregnancy. Conclusions: As of January 2022, >7000 cases from >100 fertility facilities have been registered in the JOFR. In the future, maintaining JOFR to disseminate information on cancer prognoses, pregnancy rates, and other oncofertility outcomes is expected to drive further expansion of oncofertility services in Japan.

DOI： 10.1089/jayao.2022.0110

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/iju.15047

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English  

Introduction: We report a case series of six patients with a chief complaint of infertility who underwent microsurgical varicocelectomy for intratesticular varicocele (ITV) after undergoing orchiopexy for undescended testis in their childhood. Case presentation: The patients' median age was 34 years. The median age at which orchiopexy was performed was 4.5 years. All the cases of ITV were accompanied by extratesticular varicocele (ETV). All the patients underwent a microsurgical subinguinal varicocelectomy. At 3 months after operation, the ITV and ETV had disappeared in all the cases. Sperm density and motility increased in five and four patients, respectively. Conclusion: ITV occurs at a relatively high frequency after orchiopexy for undescended testis. Disorder of the valvular function of the testicular vein in peeling the testicular vessels was thought to be a primary cause and is often found on the left side. Doppler ultrasonography of the testis is considered important for diagnosis.

DOI： 10.1002/iju5.12498

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Language：English   Publishing type：Research paper (scientific journal)  

Penile cancer is a rare cancer for which no medical guidelines have been established before in Japan. These guidelines aim to standardize, as much as possible, the therapeutic modality for penile cancer, for which empirical evidence is limited on a global scale, thereby bolstering therapeutic outcomes for patients with penile cancer. The new guidelines conform to the Minds Guide for Developing Clinical Practice Guidelines (2017) as much as possible. However, virtually no randomized comparative studies and meta-analyses based on such randomized studies have been conducted. Therefore, only the findings available at present were listed after conducting an exhaustive literature review of items with extremely low evidence levels and for which bodies of evidence and grades of recommendation were not evaluated. Clinical questions were set for items with a relatively large number of studies, including retrospective studies. However, since it is virtually impracticable to summarize bodies of evidence by systematic reviews, recommendation grades and evidence levels were discussed and determined by the consensus panel of the Preparatory Committee. The following were outlined: epidemiological, pathological, diagnostic, therapeutic, follow-up, and quality of life-related findings. Additionally, seven clinical questions were established to determine recommendation grades and evidence levels. We hope that these guidelines will prove to be useful to medical professionals engaged in clinical practice related to penile cancer in Japan and anticipate that critical reviews of the guidelines will lead to further refinement of the next edition.

DOI： 10.1111/iju.14924

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PURPOSE: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. MATERIALS AND METHODS: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. RESULTS: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. CONCLUSIONS: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.

DOI： 10.5534/wjmh.210191

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PURPOSE: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. MATERIALS AND METHODS: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. RESULTS: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. CONCLUSIONS: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

DOI： 10.5534/wjmh.220048

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AIM: The actual status of fertility preservation treatments in the startup phase in Japan was investigated as a basis for discussing future directions. METHODS: This study was conducted as "Research project to promote support of children and parenting 2016" which was supported by Ministry of Health in Japan with the approval of the institutional review board at St. Marianna University. Subjects of the survey were facilities registered with the Japan Society of Obstetrics and Gynecology as fertility preservation facilities, and facilities belonging to the Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories. We provided questionnaires to survey both the medical care system and cases for which fertility preservation was implemented between 2006 and 2016. RESULTS: Responses were obtained from 68 facilities (of the 64, 59 [92.2%] responded to the questionnaire and 9 clinics cooperated). Many facilities limited the cryopreservation of oocytes and ovaries to patients 40-41 years old and the use of eggs to patients 44-45 years old. In the patient survey, 812 cases of oocyte cryopreservation and 201 cases of ovarian tissue cryopreservation were performed during study period. Breast cancer was the most indicated disease, with oocyte cryopreservation in the late 30s and ovarian tissue cryopreservation in the early 30s. Very few babies were born from fertility preservation, and no live birth cases of ovarian tissue cryopreservation were identified. CONCLUSIONS: Even from the early days, fertility preservation was implemented according to certain standards in Japan, but was characterized by a large variety of facilities.

DOI： 10.1111/jog.15199

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OBJECTIVE: To evaluate the efficacy of keishibukuryogan, a traditional Kampo formula known to be an anti-Oketsu (impaired microcirculation and non-physiological blood congestion) drug, in combination with an anti-oxidant for the treatment of varicoceles. METHODS: We retrospectively analyzed 119 patients with palpable and subclinical varicoceles who were treated with 7.5 g/day of keishibukuryogan and 600 mg/day of tocopherol nicotinate. Their motile sperm concentrations at the start of medication and after 3 months were compared. As a subgroup analysis, a comparison test was carried out between patients with a high-grade varicocele and those with a low-grade varicocele. RESULTS: The mean age of the study patients was 35.6 years. Among them, 17, 41, 44 and 17 had subclinical, grade 1, grade 2 and grade 3 varicoceles, respectively. Overall, the differences in motile sperm concentration (millions/mL) before and after treatment were not significant (median 0.58, 95% confidence interval -0.12 to 1.56; P = 0.115). The results of the subgroup analysis showed that the motile sperm concentration in patients with a low-grade varicocele significantly increased (median 1.21, 95% confidence interval 0.45-2.47; P = 0.024); however, no significant improvements were seen in patients with a high-grade varicocele. CONCLUSIONS: The results of the present study showed that the combination of keishibukuryogan and an anti-oxidant had a limited effect on varicoceles, but they suggest that it is effective for the treatment of low-grade varicoceles.

DOI： 10.1111/iju.14746

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Klinefelter syndrome and monozygotic twins are both rare. The reports of monozygotic twins with Klinefelter syndrome to have undergone fertility treatment are uncommon. This case report describes a case of 30-year-old monozygotic adult twin brothers diagnosed with nonmosaic Klinefelter syndrome following the complaint of infertility. The result of semen analysis showed cryptozoospermia (very low sperm count) and azoospermia (zero sperm count) with physical findings and lifestyles being very similar. They both underwent microtesticular sperm extraction. One had successful sperm retrieval and achieved pregnancy through intracytoplasmic sperm injection, whereas the other did not. Testicular pathological findings showed Sertoli cell-only syndrome. To the best of our knowledge, this is the first report on monozygotic adult twins both of whom underwent microtesticular sperm extraction and resulted in different outcomes.

DOI： 10.1111/and.14266

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DOI： 10.1002/rmb2.12483

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DOI： 10.4103/aja2021112

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PURPOSE: In this pilot study, the authors compared the effects of antioxidant co-supplementation therapy and methylcobalamin therapy in patients with impaired semen quality. METHODS: Eighty-four subjects who visited male infertility clinics and showed abnormal semen test results were randomly subjected to one of the two therapies: antioxidant co-supplementation therapy with vitamin C, vitamin E, coenzyme Q10, and flaxseed oil or methylcobalamin therapy. The oxidation-reduction potential (ORP) and 8-hydroxy-2'-deoxyguanosine levels were used as indicators of oxidative stress levels in semen. Semen analysis was also performed. RESULTS: The authors obtained results from 67 patients who had completed 3 months of treatment. Neither antioxidant co-supplementation therapy nor methylcobalamin therapy changed the semen parameters significantly (except for the sperm concentration, which was increased by the latter therapy). When the pre-treatment ORP value in semen was higher than the cutoff value, both therapies significantly increased the sperm concentration. The 8-hydroxy-2'-deoxyguanosine level did not yield any meaningful predictive value with regard to increased sperm concentrations. CONCLUSIONS: Both antioxidant co-supplementation therapy and methylcobalamin therapy increased the sperm concentration in patients with impaired semen quality when the basal ORP levels in their semen were elevated.

DOI： 10.1002/rmb2.12450

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BACKGROUND: Newly emerging serious post-treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life. METHODS: We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction. MAIN FINDINGS: Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility-preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder. CONCLUSION: Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.

DOI： 10.1002/rmb2.12481

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Publishing type：Research paper (scientific journal)   Publisher：Medknow  

DOI： 10.4103/aja202152

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Cancer therapy has priority over fertility preservation. The time available for fertility preservation in patients with cancer is often very limited and depends on the condition of the underlying disease. This case report presents the results of two rounds of controlled ovarian stimulations (COSs) performed after an induced abortion. The patient had mixed phenotype acute leukemia diagnosed during early pregnancy and underwent a surgical abortion, followed by ovarian stimulation using urinary follicle-stimulating hormone (uFSH) and gonadotropin-releasing hormone (GnRH) agonists. Oocyte retrieval was subsequently performed for oocyte cryopreservation. Despite good hormonal and ultrasonic follicular growth, no oocytes were obtained. During a second COS performed at a low human chorionic gonadotropin (hCG) level (less than 100 IU/L), several mature oocytes were obtained, suggesting that higher hCG levels during COS induce the absence of mature oocytes during normal follicular growth. It is recommended to start COS post-abortion after confirming a low hCG level while considering the timing of cancer treatment.

DOI： 10.1080/09513590.2021.1950135

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: As age increases, oxidative stress increases, sperm motility decreases, and DNA fragmentation increases. To date, reports of age-related effects on semen have focused on reactive oxygen species (ROS) or total antioxidant capacity (TAC) as indicators of oxidative stress. However, assessments of ROS and TAC must be considered within a more comprehensive context in order to correctly evaluate oxidative stress and interpret findings. In this regard, the purpose of this study was to investigate the relationship between the static oxidation reduction potential (sORP) and paternal age with the goal of using the sORP as an indicator of semen oxidative stress. MATERIALS AND METHODS: Semen samples from 173 men were analyzed for the following parameters: volume, motility, and beat cross frequency (BCF). The sORP was measured by using the MiOXSYS™ system. The correlation between semen parameters and the sORP level was analyzed as a function of age. The rate of sORP positivity was compared between men <34 and ≥34 years of age, with a positive sORP defined as a level ≥1.38. RESULTS: Volume, motility, and BCF were negatively correlated with age (p<0.001). The semen sORP level was positively correlated with age (p<0.05). The rate of sORP positivity was significantly increased in men ≥34 years of age compared with that in men <34 years of age (33% compared with 12%, respectively; p<0.01). CONCLUSIONS: The sORP may play a role in age-related decreases in semen parameters (volume, motility, and BCF). The rate of sORP positivity increased significantly after 34 years of age.

DOI： 10.4111/icu.20200066

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Background: Between 30% and 80% of patients with male infertility produce excessive reactive oxygen species (ROS) in their ejaculate even though the cause of male infertility is unexplained in approximately half of cases. The strong connection between oxidative stress (OS) and male infertility has led recent investigators to propose the term "Male Oxidative Stress Infertility (MOSI)" to describe OS-associated male infertility. Methods: We searched the PubMed database for original and review articles to survey the effects of OS on male infertility, and then verified the effects and treatments. Main findings: Seminal plasma contains many antioxidants that protect sperm from ROS, because low amounts of ROS are required in the physiological fertilization process. The production of excessive ROS causes OS which can lower fertility through lipid peroxidation, sperm DNA damage, and apoptosis. Several assays are available for evaluating OS, including the MiOXSYS® analyzer to measure oxidation-reduction potential. Several measures should be considered for minimizing OS and improving clinical outcomes. Conclusion: Accurately diagnosing patients with MOSI and identifying highly sensitive biomarkers through proteomics technology is vital for better clinical outcomes.

DOI： 10.1002/rmb2.12353

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Background: At present, one out of six couples is infertile, and in 50% of cases, infertility is attributed to male infertility factors. Genetic abnormalities are found in 10%-20% of patients showing severe spermatogenesis disorders, including non-obstructive azoospermia. Methods: Literatures covering the relationship between male infertility and genetic disorders or chromosomal abnormalities were studied and summarized. Main findings Results: Genetic disorders, including Klinefelter syndrome, balanced reciprocal translocation, Robertsonian translocation, structural abnormalities in Y chromosome, XX male, azoospermic factor (AZF) deletions, and congenital bilateral absence of vas deferens were summarized and discussed from a practical point of view. Among them, understanding on AZF deletions significantly changed owing to advanced elucidation of their pathogenesis. Due to its technical progress, AZF deletion test can reveal their delicate variations and predict the condition of spermatogenesis. Thirty-nine candidate genes possibly responsible for azoospermia have been identified in the last 10 years owing to the advances in genome sequencing technologies. Conclusion: Genetic testing for chromosomes and AZF deletions should be examined in cases of severe oligozoospermia and azoospermia. Genetic counseling should be offered before and after genetic testing.

DOI： 10.1002/rmb2.12336

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Informa UK Limited  

Although reactive oxygen species in semen are associated with unfavorable results with respect to assisted reproductive technology, their effects based on the detailed stages of embryo development are unclear. We investigated the relationship between reactive oxygen species in semen and the oocyte fertilization rate, cleavage rate, and blastulation rate of intracytoplasmic sperm injections. This retrospective study enrolled 77 couples who underwent intracytoplasmic sperm injection and analyzed 887 eggs from 141 cycles of intracytoplasmic sperm injection. The reactive oxygen species level in semen was compared between the fertilized and nonfertilized groups, between the good-cleavage-embryo and non-developed-embryo groups, and between the good-quality-blastocyst and poor-quality-blastocyst groups. The cut-off level of reactive oxygen species was calculated to predict good-cleavage-embryo and good-quality-blastocyst development. The fertilization rate was 65.4%, and the mean reactive oxygen species levels were not significantly different between the fertilized and nonfertilized groups. The reactive oxygen species level was significantly higher in the non-developed-embryo group than in the good-cleavage-embryo group (P = 0.0026) and was significantly lower in the good-quality-blastocyst group than in the poor-quality-embryo group (P = 0.015). Cleavage embryos and blastocysts were divided into high- and low-reactive-oxygen-species groups using a cut-off value of 6601 and 4926 relative light units, as calculated from the receiver operating characteristic curve. The rates of good-cleavage embryos and good-quality blastocysts were lower in the high-reactive-oxygen-species group than in the low-reactive-oxygen-species group, which were both statistically significant. To conclude, reactive oxygen species in semen is considered to have an adverse effect on both the early and late stages of embryo development in intracytoplasmic sperm injection.Abbreviations: GnRH, gonadotropin-releasing hormone; ICSI, intracytoplasmic sperm injection; IVF, invitro fertilization; LPO, lipid peroxidation; NADPH, nicotinamide adenine dinucleotide phosphate; RLU, relative light units; ROC, receiver operating characteristic; ROS, reactive oxygen species.

DOI： 10.1080/19396368.2020.1720865

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

Introduction: Post-orgasmic illness syndrome is a rare condition that occurs after ejaculation and persists for 2-7 days and is characterized by flu-like symptoms, which can significantly reduce quality of life. Case presentation: A 21-year-old unmarried man was referred to our hospital due to flu-like symptoms that developed after ejaculation by masturbation and persisted for about 2 days. The patient's free testosterone level was slightly lower than normal. Nonsteroidal anti-inflammatory drugs were initially administered and helped relieve headache and muscle pain. Thereafter, the patient was able to ejaculate three times a week. In addition, after administering testosterone enanthate once or twice a month, his general fatigue significantly improved, and he could ejaculate every day. Conclusion: The pathophysiology of post-orgasmic illness syndrome has not been fully elucidated. The treatments for this condition must be accurately selected according to pathophysiology.

DOI： 10.1002/iju5.12184

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Impact Journals LLC  

Background: Sarcopenia was initially recognized as a marker representing the nutritional condition or aging. Recently, sarcopenia has been associated with a poor prognosis and postoperative complications. We examined the importance of sarcopenia as a predictive marker of the prognosis in penile cancer. Materials and Methods: A total of 25 patients diagnosed with penile cancer who underwent penile resection from 2000 to 2010 were analyzed in this study. The psoas muscle index (PMI) was calculated based on psoas area using preoperative axial computed tomography images at the right L3 level divided by the square of the body height. Results: Nineteen (76.0%) patients underwent partial penectomy, and 6 (24.0%) underwent total penectomy. The median (mean ± standard deviation) age was 69.3 (69.0 ± 10.1) years old. Regarding the site of penile cancer, 17 (76.0%) cases were in the glans, 6 (24.0%) were in the foreskin, and 2 (8.0%) were in the shaft. Lymph node metastasis were seen in 6 cases (24.0%), and distant metastasis was seen in 1 case (4.0%). The lower PMI group (&lt
320.0) showed a significantly poorer progression-free survival than the higher PMI group (≥ 320.0) (p = 0.030), although no significant difference in the overall survival was noted (p = 0.076). Conclusions: Sarcopenia might be a useful prognostic factor in penile cancer patients.

DOI： 10.18632/oncotarget.27719

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Advanced treatments have improved the prognosis of cancer survivors. Anticancer drugs generate large amounts of cellular reactive oxygen species (ROS), but their direct effects on sperm ROS production are unclear. We examined 64 semen samples of men who had received cancer chemotherapy, 467 semen samples of men consulting for idiopathic infertility, and 402 semen samples of partners of female patients as a control group. ROS production was calculated as the integrated chemiluminescence between 0 and 200 seconds after the addition of luminol to unwashed semen. We found that their ROS-positive rate of semen samples in the chemotherapy group was significantly higher than that in the control group. We compared the sperm parameters (concentration and motility) and the ROS production levels between chemotherapy subgroups and one of the remaining subgroups with positive ROS, and we found that only sperm motility was significantly lower in the samples in the postchemotherapy subgroup than in the idiopathic infertility subgroup, and that both sperm parameters were significantly lower in those from postchemotherapy subgroup than in the control subgroup. The ROS production level per million spermatozoa in the postchemotherapy subgroup was significantly higher than that in the control subgroup. Additionally, we compared variables, such as age, sperm features, and the duration from the end of the treatment to the first consultation between ROS-positive and ROS-negative subgroups in samples from men in the postchemotherapy group, but we found no significant differences. Of the men in the postchemotherapy group, three underwent a long-term antioxidant therapy, and all of them had low ROS semen levels after that. In conclusion, the production of ROS in semen detected by chemiluminescence from men who undergo cancer chemotherapy is similar to that of men with idiopathic infertility, and long-term oral antioxidant therapy may reduce the amount of ROS in the semen.

DOI： 10.3390/antiox8100449

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DOI： 10.5534/wjmh.190055

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DOI： 10.1016/j.fertnstert.2019.07.484

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本性機能学会  

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BACKGROUND: We reported previously the usefulness of 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to predict prognosis of renal cell carcinoma (RCC) treated with molecular targeted agents. Herein we describe a preliminary research of nine patients who underwent FDG-PET/CT before and after initiation of nivolumab. METHODS: Patients with metastatic RCC who were treated by nivolumab from October 2016 to March 2017 were enrolled in this study. All patients underwent FDG-PET/CT at baseline and 1 month as a first response assessment, and contrast-enhanced or non-contrast-enhanced CT scan at 4 month as a second response assessment. Logistic regression analysis was performed to assess the association of potential predictors, including age, gender, baseline diameter, baseline maximum standardized uptake value (SUVmax), lung or not lung metastasis, elevation of SUVmax at 1st assessment, and decrease in diameter at 1st assessment with the response at 2nd assessment (decrease in the diameter ≥ 30% or not). RESULTS: There were 9 patients and 30 lesions. Mean days of first assessment with FDG-PET/CT and second assessment by CT scan from initiation of treatment were 32.3 ± 6.4, 115.5 ± 14.9, respectively. Lesions whose diameter decreased ≥30% at second assessment were defined as responding, and lesions whose diameter did not decrease ≥30% were defined as non-responding. There were 18 responding lesions, and 12 non-responding lesions. We compared change in diameter and SUVmax at first assessment with FDG-PET/CT, respectively. All lesions with decreased diameter and elevated SUVmax at first assessment with FDG-PET/CT showed responding at second assessment by CT scan, while most lesions with increased diameter and declined SUVmax at first assessment showed non-responding at second assessment. The multivariate logistic regression analyses revealed that only the elevation of SUVmax at 1 month was an independent predictor (P = 0.025, OR: 13.087, 95%CI: 1.373-124.716). CONCLUSION: Our findings suggest that the early assessment using FDG-PET/CT can be effective to predict the response of RCC to nivolumab. However, larger prospective studies are needed to confirm these preliminary results. TRIAL REGISTRATION: Registered in University Hospital Medical Information Network in JAPAN [ UMIN0000008141 ], registration date: 11 Jun 2012.

DOI： 10.1186/s12885-019-5510-y

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Introduction: Testicular epidermal cysts in Klinefelter syndrome are very rare. We report a case of Klinefelter syndrome associated with a testicular epidermal cyst. To our knowledge, this is the first report showing successful spermatozoa retrieval from the affected testis. Case presentation: A 25-year-old married man was referred to our hospital with right scrotal induration, which was in lower pole of the right testis. Testicular cancer tumor markers were normal; endocrinological findings indicated hypergonadotropic hypogonadism. Semen analyses revealed azoospermia. Preoperative chromosome test result: 47, XXY karyotype; ultrasonography report: 1.9-cm internal heterogeneous echoic mass in the right testis (malignancy not discarded). Because the patient hoped for children, he underwent high orchiectomy with ipsilateral testicular sperm extraction (200 spermatozoa from normal testicular tissue) for future fertilization procedures. Tumor pathology was an epidermal cyst. Conclusion: While performing orchiectomy for testicular tumors, sperm retrieval should be attempted from normal tissues in patients planning for children.

DOI： 10.1002/iju5.12037

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BACKGROUND: Treatment advancements have improved young cancer patients' survival rate considerably. Fertility preservation has become a very important tool in the prevention of treatment-induced gonadal toxicity. This study aimed to examine hematologists' awareness of its necessity and importance. METHODS: Questionnaires were mailed to the directors of 230 institutes that treated hematological malignancies in adults. The directors were asked to provide information regarding their institutes, collaboration with sperm banks, the number of patients treated per year, selection criteria for patients providing information, and their awareness of and attitudes toward sperm preservation. RESULTS: The response rate was 40.0%. Municipal and private hospitals treated patients significantly less frequently relative to university hospitals (p = .002). Of the 92 participating hematology institutions, 17 included sperm banks and 69 collaborated with sperm banks in neighboring institutions. Many participants stated that sperm preservation should be performed before chemotherapy; however, only 38% provided sperm preservation information to all patients. Participants in facilities without sperm banks exhibited significantly lower levels of knowledge regarding sperm preservation, relative to those from institutions with sperm banks, and found discussing fertility preservation burdensome. This trend was identical to that observed in a survey conducted 10 years earlier. CONCLUSION: Many hematologists did not appear to possess sufficient knowledge regarding fertility preservation. Moreover, few institutions included sperm banks, and a considerable burden was exerted on hematologists. The introduction of support systems is required to promote sperm preservation before cancer treatment.

DOI： 10.1007/s10147-018-1334-z

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Institute of Electrical Engineers of Japan  

Automatic sperm detection is in high demand for supporting Testicular Sperm Extraction (TESE). On the other hand, detection of sperms in samples of TESE is difficult because there are a lot of germ cells resembling sperms. This paper realizes automatic sperm detection for TESE by using Adaptive Thresholded Boosting (ATBoost) which is robust to overlap of feature distributions between positive samples and negative samples. In this paper, we evaluated our sperm detection method in two stages from the view point of robustness to the overlap. First, we quantitatively evaluated the overlap of the feature distributions in TESE in the metric of Bayes error rate. Second, we evaluated robustness of our sperm detection method as for the overlap. These two results show that our sperm detection method is very effective for TESE.

DOI： 10.1541/ieejeiss.139.1461

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Bentham Science Publishers B.V.  

Background: Renal transplantation is a useful option for allowing female renal failure patients of childbearing age to achieve pregnancy. However, there have been a few reports on the effects of renal transplantation on infertility treatment in male renal failure patients. We herein report two cases in which male patients underwent infertility treatment after renal transplantation. Case Presentation: Case 1: A 51-year-old Asian (Japanese) man underwent transplantation (the donor was his wife) for renal failure due to Autosomal Dominant Polycystic Kidney Disease (ADPKD). At two years after transplantation, he visited the reproduction center in our institute due to infertility. A semen analysis revealed oligoasthenozoospermia. He ultimately failed to achieve pregnancy and gave up on infertility treatment. Case 2: A 47-year-old Asian (Japanese) man underwent renal transplantation (the donor was his sister) due to renal failure caused by diabetes mellitus. At three years after renal transplantation, he visited the reproduction center in our institute for infertility. Due to ejaculation disability and the absence of sperm in the patient’s urine after masturbation, he was diagnosed with anejaculation. Thus, testicular sperm extraction (TESE) was performed. Twenty-three motile spermatozoa were successfully retrieved by microdissection TESE (micro-TESE). ICSI was subsequently performed and a good embryo was transferred. His wife achieved pregnancy and is expected to deliver this October. Conclusion: We report two cases of male infertility treatment after renal transplantation.

DOI： 10.2174/1874303X01912010001

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BACKGROUND: Bladder cancers have been characterized as a tumor group in which the immunological response is relatively well preserved. Programmed death ligand 1 (PD-L1, B7-H1, CD274) has been shown to be expressed in several malignancies, including bladder cancer. However, the clinicopathological impact of this biomarker has not yet been established. In the present study, a quantitative real-time polymerase chain reaction (qPCR) was performed using paired normal and cancerous bladder cancer tissue to investigate PD-1/PD-L1 gene expression. METHODS: We examined the mRNA expression of PD-1/PD-L1 by a qPCR using 58 pairs of normal and cancerous human bladder tissue specimens. We also examined the correlation with the expressions of the STAT1 and NFAT genes, which are thought to be upstream and downstream of the PD-L1 pathway, respectively. RESULTS: There were no significant differences between normal and cancerous tissue in the expression of the PD-1 and PD-L1 genes (p = 0.724 and p = 0.102, respectively). However, PD-1 and PD-L1 were both more highly expressed in high-grade bladder cancer than in low-grade bladder cancer (p < 0.050 and p < 0.010). PD-L1 was positively correlated with the expressions of both the STAT1 (r = 0.681, p < 0.001) and the NFATc1 genes (r = 0.444. p < 0.001). CONCLUSIONS: PD-1 and PD-L1 might be a new biomarker that correlates with the pathological grade of bladder cancer. PD-L1 might function as a mediator of stage progression in bladder cancer and STAT1-NFAT pathway might associate this function.

DOI： 10.1186/s12894-018-0414-8

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Birt-Hogg-Dubé (BHD) syndrome is a hereditary kidney cancer syndrome, which predisposes patients to develop kidney cancer, cutaneous fibrofolliculomas and pulmonary cysts. The responsible gene FLCN is a tumor suppressor for kidney cancer, which plays an important role in energy homeostasis through the regulation of mitochondrial oxidative metabolism. However, the process by which FLCN-deficiency leads to renal tumorigenesis is unclear. In order to clarify molecular pathogenesis of BHD-associated kidney cancer, we conducted whole-exome sequencing analysis using next-generation sequencing technology as well as metabolite analysis using liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry. Whole-exome sequencing analysis of BHD-associated kidney cancer revealed that copy number variations of BHD-associated kidney cancer are considerably different from those already reported in sporadic cases. In somatic variant analysis, very few variants were commonly observed in BHD-associated kidney cancer; however, variants in chromatin remodeling genes were frequently observed in BHD-associated kidney cancer (17/29 tumors, 59%). Metabolite analysis of BHD-associated kidney cancer revealed metabolic reprogramming toward upregulated redox regulation which may neutralize reactive oxygen species potentially produced from mitochondria with increased respiratory capacity under FLCN-deficiency. BHD-associated kidney cancer displays unique molecular characteristics that are completely different from sporadic kidney cancer, providing mechanistic insight into tumorigenesis under FLCN-deficiency as well as a foundation for development of novel therapeutics for kidney cancer.

DOI： 10.1093/hmg/ddy181

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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This study aimed to ascertain the current status of Japanese sperm banking for young cancer patients. During 2015, we mailed the directors of 695 institutes where sperm cryopreservation might be performed with questionnaires requesting information on the number of patients, age, precryopreservation chemotherapy, semen analyses results and diagnoses, cryopreservation success rate, and causes of unsuccessful cryopreservation. Of these 695 institutes, 92 had cryopreserved sperm before chemotherapy within the study period. In all, 820 cancer patients (237 testicular, 383 hematological, 46 bone and soft tissue, 20 brain, and 134 other malignancy) consulted the responding institutes for sperm cryopreservation. Except for testicular tumor, the number of patients whose sperm was preserved before cancer treatment was low compared to that of young cancer patients. Approximately 20% of patients with malignancies other than testicular tumor underwent chemotherapy before cryopreservation. The success rate of cryopreservation in hematological malignancy was 82.5%, significantly lower than that of both the testicular cancer (93.6%) and other malignancy groups (95.6%) (P < 0.05). The primary reasons for preservation failure were azoospermia and poor semen quality. Patients with hematological malignancies had a higher rate of unsuccessful cryopreservation compared to those in other groups, possibly due to the large number of patients requesting sperm cryopreservation after chemotherapy induction. In Japan, information regarding sperm banking prior to cancer treatment appears to be lacking. Information regarding sperm preservation before chemotherapy should be provided to all Japanese oncologists.

DOI： 10.4103/aja.aja_74_17

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Urologists frequently encounter malignant ureteral obstruction (MUO) caused by advanced urological or non-urological malignant disease, but the treatment policy is unclear. The present study examined the risk factors for predicting ureteral stent failure in patients with MUO after ureteral stent insertion and the change in the renal function after retrograde ureteral stent insertion in cases of bilateral hydronephrosis. Methods: A total of 39 patients who required ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, Japan) between February 2007 and May 2016 were included in this study. The age, gender, type of cancer, hydronephrosis side, pre-stenting estimated glomerular filtration rate (eGFR), and eGFR increase were assessed as predictive factors for stent failure. Among these 39 patients, 25 showed bilateral hydronephrosis. Thirteen of these patients had bilateral ureteral stents placed, and the remaining 12 had a unilateral ureteral stent placed. The renal function and overall survival (OS) were analyzed between these two groups. Results: Among all 39 patients, 9 (23.1%) had stent failure. A univariate analysis revealed that causative disease (gastrointestinal cancer vs. others
p = 0.045) and laterality of hydronephrosis (bilateral vs. unilateral
p = 0.05) were associated with stent failure. A multivariate analysis revealed that only age (hazard ratio, 0.938
95% confidence interval, 0.883-0.996
p = 0.038) was associated with stent failure. A Kaplan-Meier analysis and log-rank test indicated that having a unilateral ureteral stent placed was not correlated with a lower OS rate than having bilateral ureteral stents placed (p = 0.563). Among patients with bilateral hydronephrosis, the increase in the eGFR of those who had bilateral ureteral stents placed was not significantly different from that of those who had a unilateral ureteral stent placed (p = 0.152). Conclusions: We revealed that age &gt
60 years was helpful for predicting stent failure. MUO due to gastrointestinal cancer and bilateral hydronephrosis may be predictive of stent failure. These factors may help urologists decide the optimal time to perform early percutaneous nephrostomy. These findings suggest that patients with bilateral hydronephrosis do not necessarily need to have a ureteral stent placed into both sides of the hydronephrosis.

DOI： 10.1186/s12894-018-0346-3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc  

We report a rare case of primary amelanotic malignant melanoma of the male urethra. A 65-year-old man with a urethral mass was referred to our hospital. A pathological diagnosis of a biopsy specimen revealed malignant melanoma. Thereafter, the patient underwent partial penectomy. The histopathological diagnosis was amelanotic malignant melanoma of the urethra. The patient had received DAV-Feron in an adjuvant setting
however, PET-CT revealed multiple metastasis. After receiving more than 10 cycles of nivolumab, the accumulation of FDG was no longer observed on PET-CT. The patient is currently free from recurrence at 20 months after nivolumab treatment.

DOI： 10.1016/j.eucr.2018.03.006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Spandidos Publications  

Primary penile cancer is a rare disease. Higher incidence rates occur in underdeveloped countries. Many studies have suggested an association between human papillomavirus (HPV) infection and penile cancer. Although HPV can affect the squamous epithelium of the male genitalia similarly to the female genital tract, the association between penile cancer and HPV remains unclear. In the present study, the HPV gene expression was examined in penile cancer tissue using in situ hybridization (ISH). The present study included 41 cases in which penectomy was performed and 3 cases in which tumor resection was performed to treat pathologically-diagnosed penile cancer at Yokohama City University Medical Center, and its 7 affiliated hospitals between April 1990 and March 2010. The penile cancer tissue was subjected to an ISH analysis, and the clinicopathological features and prognosis were investigated. A total of 5/44 cases (11.4%) showed the expression of high-risk HPV. None of the patients showed the expression of low-risk HPV. The associations between the expression of high-risk HPV, and age, tumor location, tumor size, T stage, pathological differentiation, nuclear grade, Broder's classification, pattern of invasion, Y-K grade, vascular invasion, lymphoid invasion, koilocytosis and lymph-node metastasis were then examined. Patients with a well-differentiated status (P=0.044) and Broder's Grade 1 (P=0.019) showed a significantly lower rate of HPV positivity. The HPV expression was not significantly associated with cancer specific survival (P=0.932). ISH using INFORM HPV III does not detect the HPV genotype, this method is easy to employ and may be useful for the diagnosis of penile cancer tissue, similarly to cervical cancer.

DOI： 10.3892/ol.2018.8351

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PURPOSE: We investigated prospectively whether 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) can predict the overall survival (OS) of patients with advanced renal cell carcinoma (RCC) previously treated by molecular targeted therapies. METHODS: Between 2009 and 2016, 81 patients who had received single molecular targeted therapies (43 sorafenib, 27 sunitinib, 8 temsirolimus and others) and were scheduled for second line molecular targeted therapies for advanced RCC were enrolled in this prospective study. FDG PET/CT was performed after first line molecular targeted therapies, the max SUVmax (highest standardized uptake value for each patient) recorded, and its association with OS compared with those of known risk factors. The median follow-up was 15.4 months (range 0.9-97.4 months). RESULTS: The max SUVmax of the 81 subjects ranged from undetectable to 23.0 (median 7.1). Patients with high max SUVmax had a poor prognosis and multivariate analysis with established risk factors showed that it was an independent predictor of survival (p < 0.001; hazard ratio 1.156; 95% confidence interval 1.080-1.239). Subclassification of patients by max SUVmax showed that the median OS of patients with max SUVmax < 7.0 (39), 7.0-12.0 (30), and ≥ 12.0 (12) were 32.8, 15.2, and 6.0 months, respectively. These differences are statistically significant (< 7.0 versus 7.0-12.0: p = 0.0333, 7.0-12.0 versus ≥ 12.0: p = 0.0235). CONCLUSIONS: The max SUVmax by FDG PET/CT of patients with RCC evaluated after their first molecular targeted therapy predicts OS. FDG PET/CT is a useful "imaging biomarker" for patients with advanced RCC planning sequential molecular targeted therapies.

DOI： 10.1007/s00280-018-3542-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Korean Society for Reproductive Medicine  

Onco-testicular sperm extraction is used to preserve fertility in patients with bilateral testicular tumors and azoospermia. We report the case of a testicular tumor in the solitary testis of a patient who had previously undergone successful contralateral orchiectomy and whose sperm was preserved by onco-testicular sperm extraction. A 35-year-old patient presented with swelling of his right scrotum that had lasted for 1 month. His medical history included a contralateral orchiectomy during childhood. Ultrasonography revealed a mosaic echoic area in his scrotum, suggesting a testicular tumor. The lesion was palpated within the normal testicular tissue along its edge and semen analysis showed azoospermia. Radical inguinal orchiectomy and onco-testicular sperm extraction were performed simultaneously. Motile spermatozoa were extracted from normal seminiferous tubules under microscopy and were frozen. Eventual intracytoplasmic sperm injection using the frozen spermatozoa is planned. Onco-testicular sperm extraction is an important fertility preservation method in patients with bilateral testicular tumors or a history of a previous contralateral orchiectomy.

DOI： 10.5653/cerm.2018.45.1.44

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Korean Society for Reproductive Medicine  

We report the case of a 46-year-old Chinese male patient who visited our clinic complaining of infertility. Semen analysis revealed azoospermia, and azoospermia factor c region partial deletion (b1/b3) was detected using Y chromosome microdeletion analysis. Testicular sperm extraction was performed after genetic counseling. The bilateral ductus deferens and a portion of the epididymis were absent, whereas the remaining epididymis was expanded. Motile intratesticular spermatozoa were successfully extracted from the seminiferous tubule. On histopathology, nearly complete spermatogenesis was confirmed in almost every seminiferous tubule. To our knowledge, this is the first case report of b1/b3 deletion with a congenital bilateral absence of the vas deferens and almost normal spermatogenesis.

DOI： 10.5653/cerm.2018.45.1.48

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Language：Japanese   Publisher：(NPO)日本がん・生殖医療学会  

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Lenalidomide has been developed as the derivative of thalidomide that has fewer side effects. We herein report a rare case of castration-resistant prostate cancer successfully maintained using lenalidomide for multiple myeloma.

DOI： 10.1002/ccr3.1328

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Language：Japanese   Publisher：(NPO)日本がん・生殖医療学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

Prostate basal cell carcinoma (PBCC) accounts for 0.01% of all prostate cancers. A 68-year-old man complained of dysuria for 5 years on his initial visit. His PSA level was 3.87 ng/mL. Due to a diagnosis of benign prostate hyperplasia, he underwent transurethral resection of the prostate. A pathological examination revealed that basal cell-like atypical cells made alveolar with palisadal layout. Immunohistochemical analysis showed positive 34β12, P63, and Ki-67. Based on these findings, PBCC was diagnosed. Then, we performed radical prostatectomy. He was free from recurrence 22 months after the operation. We herein report an extremely rare case of PBCC.

DOI： 10.1159/000487389

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：John Wiley and Sons Ltd  

Purpose: To investigate the incidence, etiology, treatment indications, and outcomes regarding infertile male patients in Japan. Methods: Between April, 2014 and March, 2015, the authors contacted 47 clinical specialists in male infertility who had been certified by the Japan Society for Reproductive Medicine. The participating clinicians were sent a questionnaire regarding information on their infertile patients, according to etiology and the number and success rates of male infertility operations that had been performed in their practice. Results: Thirty-nine specialists returned the questionnaire and provided information regarding 7268 patients. The etiology of infertility included testicular factors, sexual disorders, and seminal tract obstruction. During the study year, the clinicians performed varicocelectomies, testicular sperm extractions (TESEs), and re-anastomoses of the seminal tract. The rate of successful varicocelectomies was &gt
70%. The sperm retrieval rates with conventional TESE and microdissection TESE were 98.3% and 34.0%, respectively, while the patency rates with vasovasostomy and epididymovasostomy were 81.8% and 61.0%, respectively. Conclusion: Surgical outcomes for infertile male patients are favorable and can be of great clinical benefit for infertile couples. To achieve this, urologists should work in collaboration with gynecological specialists in order to optimize the treatment of both partners.

DOI： 10.1002/rmb2.12065

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

This research aims to realize sperm selection support system for assisted reproductive technology. Sperm detection is one of the important component technology. High detection rate is required even the expense of false positive detections so as not to miss promising sperms as much as possible. False positive rate control is key technology for assure high detection rate and adaptive threshold adjustment methods in boosting is proposed. Our experiments evaluate and compare adaptive thresholding method and normal thresholding method as for detection rate and false positive rate of sperm detection.

DOI： 10.1109/SMC.2018.00339

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Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

DOI： 10.1109/SMC.2018.00339

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Language：Japanese   Publisher：医学図書出版(株)  

精索静脈瘤に対する顕微鏡下低位結紮術33例の初期治療成績につき検討した。年齢は35.5±6.5歳(平均±標準偏差)。術前運動精子濃度は1.9±2.0M/mL、術後3・6ヵ月の運動精子濃度は5.5±8.0M/mL(P<0.014)、6.5±7.8M/mL(P<0.002)と有意な改善がみられた。明らかな合併症を認めなかった。諸家の報告通り、顕微鏡下低位結紮術は安全かつ良好な治療効果が期待できる。(著者抄録)

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OBJECTIVE: Urethral stenosis is a disease in which the lumen of the urethra becomes constricted by fibrosis. Such stenoses have been treated by urethral dilation using a bougie and optical internal urethrotomy (OIU). Recently, high-pressure balloon dilation (BD) has been developed as a new treatment method for urethral stenosis. The present study compared the effectiveness of urethral dilation by BD and OIU. METHODS: Twenty-two patients of urethral stenosis were treated at Yokohama City University Medical Center between 2005 and 2015. Of these, 13 underwent BD, whereas OIU was performed in 9. BD was performed at 30 atm twice for 5 min each time. In OIU, an endoscopic knife was used to cut out the stenotic lesion in 3 directions. The endpoint was set as restenosis, which required additional surgical treatment, including BD, OIU, and the use of a urethral bougie. RESULTS: The causes of urethral stricture were endoscopic surgery (n = 7; 31.8%), development after total prostatectomy (n = 4; 18.2%), iatrogenic reasons associated with catheter insertion (n = 5; 22.7%), development after a prostate needle biopsy (n = 3; 13.6%), and unknown (n = 3; 13.6%). The site of the stenotic lesion site was the anastomosis (n = 3; 13.6%), bladder neck (n = 6; 27.3%), prostatic urethra (n = 4; 18.2%), anterior urethra (n = 7; 31.8%), and membranous urethra (n = 2; 9.1%). The stenosis-free rate was 84% for those undergoing BD and 22% for those receiving OIU. The median stenosis-free time was significantly longer after BD than OIU (1675 vs. 244 days, respectively; P < .01). CONCLUSION: The stenosis-free time was significantly longer after BD than OIU.

DOI： 10.1111/luts.12208

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Paraganglioma is an extra site of pheochromocytoma. Paraganglioma in the bladder is a very rare disease accounting for 0.06% of all bladder tumors. Case presentation: A 77-year-old Japanese man was referred to our department for the further examination of a bladder tumor detected on preoperative computed tomography of his gastric cancer. Cystoscopy revealed a submucosal tumor in the upper area of his bladder, so transurethral resection of the bladder tumor was performed. During transurethral resection of the bladder tumor, his blood pressure sharply increased, and a pathological examination showed paraganglioma in his bladder. Postoperative I-123-metaiodobenzylguanidine scintigraphy detected a higher intake of his bladder tumor. Laboratory examinations showed a slightly increased noradrenaline level of 530 pg/ml and reduced platelet count at 167,000/μL. Based on the progression of his gastric cancer, no additional therapy was performed on his bladder tumor. Eight months after surgery, he died from aspiration pneumonitis. Conclusions: Here we report a rare case of paraganglioma in the bladder. We discuss paraganglioma based on previous studies.

DOI： 10.1186/s13256-017-1473-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：John Wiley and Sons Ltd  

Purpose: To determine whether reactive oxygen species (ROS) in semen samples could be measured with the Monolight™ 3010 Luminometer. Methods: Using the Monolight™ 3010 Luminometer, the ROS was measured in the unprocessed semen samples of infertile male patients, as well as the luminescence of 190 semen samples. The samples were classified as “luminescence-detectable” (n = 89) and “luminescence-undetectable” (n = 101). Thereafter, the luminescence of the semen samples that had been obtained from the 715 infertile patients was measured and compared by using Sperm Motility Analyzing System measurements. Moreover, in order to investigate the ROS measurement consistency, the chemiluminescence values of 84 samples were measured concurrently by using the Monolight™ 3010 Luminometer and the 1251 Luminometer™. Results: The semen volume, sperm motility, and progressive motility of the samples were significantly higher in the luminescence-undetectable samples. The sperm motility, straight-line velocity, curvilinear velocity, mean amplitude head displacement, beat cross frequency, and progressive motility showed an inverse correlation with the logarithmic-transformed luminescence level in the luminescence-detected samples. The integrated chemiluminescence levels in the 84 samples were correlated. Conclusion: The substance that was measured in the unprocessed semen with the Monolight™ 3010 Luminometer and stimulated chemiluminescence is ROS.

DOI： 10.1002/rmb2.12052

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ediciones Doyma, S.L.  

In the above published article, errors have been detected in the values of motility and concentration, and also in the caption of Figure 2. The corrected values are: Motility 0.538 Concentration 0.641 The corrected figure caption is: Figure 2 The scatterplots of the relationship between SMI and each semen parameter using the Spearman correlation coefficient. There was significant correlation between SMI and motility (ρ = 0.538), concentration (ρ = 0.641), straight-line velocity (VSL) (ρ = 0.352), curvilinear velocity (VCL) (ρ= 0.360), mean amplitude of lateral head displacement (mALH) (ρ = 0.60), and progressive motility (PM) (ρ = 0.578), respectively (p ≤ 0.001).

DOI： 10.1016/j.androl.2017.09.001

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

症例は移植時年齢24歳男性。14歳時に白血病に対する放射線併用化学療法を施行され、治療中に神経因性膀胱に起因する膀胱尿管逆流症(vesicoureteral reflex:VUR)を指摘された。清潔間歇導尿(clean intermittent catherterization:CIC)を導入されたが通院を自己中断し、23歳時に血清Cr20mg/dLと腎機能の著明な増悪を認め血液透析を導入された。生体腎移植を希望され当科を受診したが、低コンプライアンス膀胱に伴う両側VURを認めたため下部尿路再建術を先行する二期的手術が必要と判断した。24歳時に両側VUR根治術と回腸利用膀胱拡大術を施行し、7ヵ月後に母親をドナーとする血液型適合生体腎移植を施行した。下部尿路障害を有する末期腎不全における腎移植においては、尿路再建術を先行して施行することが多い。本症例も膀胱拡大術後7ヵ月で腎移植を施行し良好に経過している。(著者抄録)

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Recently, sarcopenia has been reported as a new predictor for patient outcomes or likelihood of post-operative complications. The purpose of this study was to evaluate the association of the psoas muscle volume with the length of hospitalization among patients undergoing radical cystectomy. Methods: A total of 63 (80.8%) male patients and 15 (19.2%) female patients who underwent radical cystectomy for their bladder cancer in our institution from 2000 to 2015 were analyzed. The psoas muscle index (PMI) was calculated by normalizing the psoas muscle area calculated using axial computed tomography at the level of the umbilicus (cm2) by the square of the body height (m2). Longer hospitalization was defined as hospitalization exceeding 30 days after surgery. Results: The median PMIs (mean ± standard deviation) were 391 (394 ± 92.1) and 271 (278 ± 92.6) cm2/m2 in men and women, respectively. Thus, the PMIs of male patients were significantly larger than those of females (p &lt
0.001). Based on the differences in gender, we analyzed 63 male patients for a further analysis. In male patients, those hospitalized longer showed a significantly smaller PMI than those normally discharged (377 ± 93.1 vs. 425 ± 83.4
p = 0.04). Similarly, male patients with a small PMI (&lt
400) had a significantly worse overall survival (p = 0.02) than those with a large PMI (≥400). Conclusions: The presence of sarcopenia was found to be associated with significantly longer hospitalization after radical cystectomy in male patients. Furthermore, in men, a PMI &lt
400 may suggest a significantly worse prognosis.

DOI： 10.1186/s12894-017-0279-2

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER DOYMA SL  

Objective: To investigate the relationship between the Sperm Motility Index and the presence Reactive oxygen of reactive oxygen species, in semen.
Methods: We retrospectively analyzed Sperm Motility Index measured by the Sperm Quality Sperm Motility Index Analyzer and reactive oxygen species levels in 92 semen samples of infertile male patients who visited the Ebina Ladies' Clinic between September 2011 and June 2012. Using the same semen samples, we also analyzed 8 sperm parameters measured by computer-assisted semen analysis and validated the relationship with the Sperm Motility Index.
Results: The presence of reactive oxygen species in semen was positive in 19 samples and negative in 73 samples. In the reactive oxygen species-positive group, there was a significant negative correlation between the logarithm of reactive oxygen species level and Sperm Motility Index (p = 0.039).
Conclusions: This is the first study to find a significant negative correlation between Sperm Motility Index and reactive oxygen species level. This result indicates that the presence of reactive oxygen species in semen may inhibit the fertilization ability of spermatazoa as measured by the Sperm Motility Index. (C) 2016 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.

DOI： 10.1016/j.androl.2016.08.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: The neutrophil-to-lymphocyte ratio (NLR) is reported as a biomarker for some solid malignant diseases. Thus far, however, no reports of the relationship between the NLR and adrenal tumors have been published. We analyzed the utility of the preoperative NLR as a biomarker for predicting the prognosis or diagnosis of malignant disease.
Methods: A total of 59 patients with adrenal tumors (13 cases of malignant disease and 46 with benign disease) were analyzed in this study from February 2004 to June 2015 at our institute. The NLR was obtained just before adrenalectomy. The diagnosis of adrenal tumor was confirmed by a pathological examination of surgical specimens.
Results: The NLR in malignant adrenal tumor specimens was significantly higher than in non-malignant specimens (p = 0.028). Adrenocortical carcinoma (ACC) showed the highest NLR among all adrenal tumors. In ACC, the higher NLR group (NLR &gt;= 5) showed a significantly poorer overall survival than the lower NLR group (NLR &lt; 5) ( p = 0.032).
Conclusions: In adrenal tumors, a higher NLR indicates a higher incidence of malignancy. The NLR might be a new biomarker for predicting the prognosis of adrenal tumor patients.

DOI： 10.1186/s12894-017-0240-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS INC  

Density gradient centrifugation can separate motile sperm from immotile sperm and other cells for assisted reproduction, but may also remove antioxidants from seminal plasma, resulting in oxidative stress. Therefore, we investigated reactive oxygen species (ROS) concentrations and distribution in semen before and after density gradient centrifugation. We assessed semen volume, sperm concentration, sperm motility, and ROS levels before and after density gradient centrifugation (300 x g for 20 minutes) in 143 semen samples from 118 patients. The ROS removal rate was evaluated in ROS-positive samples and ROS formation rate in ROS-negative samples. Thirty-eight of 143 untreated samples (26.6%) were ROS-positive; sperm motility was significantly lower in these samples than in ROS-negative samples (p &lt; 0.05). After density gradient centrifugation, only seven of the 38 ROS-positive samples (18.42%) exhibited a ROS-positive lower layer (containing motile sperm) with a ROS removal rate of 81.58%, whereas the upper layer was ROS-positive in 24 samples (63.16%). In the ROS-negative group (n = 105), ROS was detected in 19 samples after centrifugation (18.10%, ROS generation rate), of which 18 were ROS-positive only in the upper layer or interface and the other was ROS-positive in both layers. Density gradient centrifugation can separate motile sperm from immotile sperm as well as remove ROS (including newly generated ROS). This data supports the view that density gradient centrifugation can select motile spermatozoa without enhancing oxidative stress.Abbreviations: ROS: reactive oxygen species; SOD: superoxide dismutase; GPx: glutathione peroxidase; DNA: deoxyribonucleic acid; DGC: density gradient centrifugation; IUI: intrauterine insemination; IVF: in vitro fertilization; HEPES: 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid; EDTA: ethylenediaminetetraacetic acid; HTF: HEPES-buffered human tubal fluid; IMSI: intracytoplasmic morphologically selected sperm injection; SMAS: sperm motility analyzing system; CASA: computer-assisted semen analyzer; WHO: World Health Organization

DOI： 10.1080/19396368.2017.1294214

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Language：Japanese   Publisher：医学図書出版(株)  

男性不妊症の多くは薬物療法が必要である。今回われわれは薬物療法を行った男性不妊症患者66名を対象とし、治療効果と治療後の妊娠有無について検討した。平均年齢は38.4歳で66例中34例が治療有効で、13例(38.2%)に妊娠が認められた。一方、治療無効の32例での妊娠は6例(18.8%)であった。薬物療法で精液所見が改善した群では改善しなかった群と比較して有意差はないものの高い妊娠率(P=0.069)を認めており、不妊治療に男性不妊診療が介入するメリットは十分にあると考えられた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Most patients with testicular cancer are infertile
thus, the preservation of the sperm after surgery is an important factor to consider. We report two cases of bilateral testicular cancer in patients who underwent bilateral higher orchiectomy and simultaneous testicular sperm extraction. Case presentation: Two Asian-Japanese men were referred to our hospital with bilateral testicular tumors. Both of the patients were preoperatively diagnosed with azoospermia and requested testicular sperm extraction at the time of higher orchiectomy. In one patient, sperm was successfully harvested and then frozen. In the other patient, sperm could not be retrieved from the patient’s testis. In both patients, the pathological diagnosis was seminoma. Testicular tumors often occur in patients of reproductive age. The preservation of sperm before chemotherapy or bilateral orchiectomy is necessary for patients with testicular tumors who wish to be fathers. Conclusions: Onco-testicular sperm extraction might be an option for patients with testicular cancer and azoospermia or severe oligospermia.

DOI： 10.1186/s13256-017-1303-6

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PURPOSE: We evaluated 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) results as outcome predictors for patients with metastatic renal cell carcinoma (RCC) treated by everolimus (EVL), an inhibitor of mammalian target of rapamycin. METHODS: We retrospectively reviewed 30 patients who were treated with EVL for metastatic RCC between May 2010 and March 2015, by evaluating their FDG PET/CT result before and 1 month after starting EVL treatment. We examined the relationships between each patient's maximum standardized uptake value (max SUVmax) assessed by FDG PET/CT on progression-free survival (PFS) and overall survival (OS). RESULTS: Median PFS for all 30 patients was 3.77 months (range 0.72-24.56 months) and median OS after EVL treatment of all 30 patients was 11.67 months (range 1.0-62.98 months). Enrolled patients were divided into two groups by max SUVmax prior to EVL (median = 7.6) and at 1 month after EVL treatment (median = 5.7). PFS were significantly shorter in higher max SUVmax prior to EVL (<7.6, PFS 7.8 vs 3.5 months, log-rank P = 0.017) and at 1 month after EVL (<5.7, PFS 10.6 vs 2.7 months, log-rank P = 0.002) than lower max SUVmax. OS were also significantly shorter in higher max SUVmax prior to EVL (<7.6, OS 18.1 vs 7.5 months, log-rank P = 0.010) and at 1 month after EVL (<5.7, OS 17.2 vs 7.5 months, log-rank P = 0.009) than lower max SUVmax. Multivariate Cox hazard regression analysis indicated that max SUVmax at 1 month after EVL is an independent predictor of both PFS and OS in patients treated with EVL although univariate regression analysis showed max SUVmax before EVL is a possible predictor. CONCLUSIONS: Max SUVmax assessed by FDG PET/CT prior to EVL and at 1 month after EVL treatment can accurately predict PFS and can guide decisions on whether to continue or change treatments for patients with EVL-treated RCC who suffer from adverse events.

DOI： 10.1007/s00280-017-3275-z

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDKNOW PUBLICATIONS & MEDIA PVT LTD  

This study investigated the correlation between sperm motion parameters obtained by a computer- assisted semen analyzer and levels of reactive oxygen species in unwashed semen. In total, 847 patients, except for azoospermic patients were investigated. At the time of each patient's first consultation, semen parameters were measured using SMAS (TM) or CelISoft 3000 (TM), and production of reactive oxygen species was measured using a computer- driven LKB Wallac Luminometer 1251 Analyzer. The patients were divided into two groups: reactive oxygen species - positive and negative. The semen parameters within each group were measured using one of the two computer- assisted semen analyzer systems and then compared. Correlations between reactive oxygen species levels and sperm motion parameters in semen from the reactive oxygen species - positive group were also investigated. Reactive oxygen species were detected in semen samples of 282 cases (33.3%). Sperm concentration (P &lt; 0.01; P &lt; 0.01), motility (P &lt; 0.01; P &lt; 0.05), and progressive motility (P &lt; 0.01; P &lt; 0.01) were markedly lower in the reactive oxygen species - positive group than in the reactive oxygen species - negative group. Among the sperm motion parameters in the reactive oxygen species - positive group, sperm concentration (P &lt; 0.01; P &lt; 0.01), motility (P &lt; 0.05; P &lt; 0.01), mALH (P &lt; 0.05; P &lt; 0.01), and progressive motility (P &lt; 0.05; P &lt; 0.01) also showed inverse correlations with the logarithmic transformed reactive oxygen species levels. Therefore, this study demonstrated that excessive reactive oxygen species in semen damage sperm concentration, motility, and other sperm motion parameters.

DOI： 10.4103/1008-682X.173933

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SCI PRINTERS & PUBL INC  

OBJECTIVE: To evaluate the efficacy of varicocele repair in patients with nonobstructive azoospermia.
STUDY DESIGN: Ten patients with nonobstructive azoospermia and clinical varicoceles who underwent varicocele repair were retrospectively investigated. According to the postoperative appearance of motile spermatozoa in the ejaculate, the patients were divided into 2 groups: Responder and Nonresponder. The outcomes of each group were investigated.
RESULTS: There were 4 (40%) patients in the Responder group. Serum follicle -stimulating hormone levels were significantly higher in the Nonresponder group than in the Responder group (19.9 +/- 6.4 IU/mL vs. 10.8 +/- 4.0 IU/mL, p &lt;0.05). Mean sperm concentration was 5.4 million spermatozoa/mL in the Responder group. One patient achieved a spontaneous pregnancy, and another achieved an assisted pregnancy. In the Nonresponder group 5 patients underwent microdissection testicular sperm extraction (micro-TESE) postoperatively. In 1 patient, motile spermatozoa were successfully retrieved. Histopathological findings in the other 4 patients were Sertoli-cell-only.
CONCLUSION: The present study suggested that var-icocele repair could be considered in men with non obstructive azoospermia who have clinical varicoceles. Moreover, varicocele repair seemed to improve sperm retrieval rate during microTESE for those in the Non responder group.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 45 year-old-man was admitted to our hospital because of discomfort in his left scrotum. He had a left testicular tumor. We performed high orchiectomy and pathological findings revealed testicular cancer. He was treated with bleomycin, etoposide and cisplatin. Computed tomography showed a new mass in the left lung after 3 cycles of the chemotherapy. Because of its rapid growth, the tumor was thought to be a metastasis lesion of testicular cancer or pulmonary infection. Transbronchial lung biopsy showed an invasion of multinucleated giant cells and granuloma. The culture and polymerase chain reaction of the bronchial sputum were positive for myobacterium avium-complex (MAC). From these findings, the left lung tumor was diagnosed as pulmonary MAC disease. He received partial resection of the left lung and the lesion was diagnosed as granuloma. There was no recurrence of testicular cancer or pulmonary disease after the surgery.

DOI： 10.14989/ActaUrolJap_63_l_31

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ltd  

Foreign bodies are occasionally reported in the bladder. In most cases, the foreign body is removed via the transurethral approach. A 57-year-old male patient was referred to our hospital to undergo the retrieval of a foreign body from his bladder. However, the foreign body had become severely calcified and could not be removed transurethrally. Thus, an open bladder wall incision was necessary to remove it. We herein report a case of a foreign body in the bladder that had become calcified and which was successfully removed using a higher bladder incision approach. A careful preoperative examination should be performed to detect the characteristics of the foreign body and avoid the risk of bladder wall perforation.

DOI： 10.1016/j.ijscr.2017.02.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Hindawi Limited  

Introduction. Xanthogranulomatous pyelonephritis (XGP) is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT) revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells
thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter.

DOI： 10.1155/2017/2392670

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：HINDAWI LTD  

Introduction and Objectives. An elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be associated with a poor prognosis in several cancers. We evaluated the utility of an elevated NLR as a biomarker to predict the prognosis of metastatic castration-resistant prostate cancer (mCRPC) patients treated with cabazitaxel (CBZ). Methods. We analyzed 47 patients who received CBZ chemotherapy for mCRPC in our institutions. The NLR was calculated using the neutrophil and lymphocyte counts before CBZ chemotherapy. We determined the NLR cut-off value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. A multivariate analysis was performed to investigate the association between the NLR and the prognosis. Results. The median overall survival (OS) after CBZ was 10.0 months (range: 6.3-13.2). The median OS was shorter in patients with a high NLR (&gt;= 3.83) than in thosewith a low NLR (&lt;3.83) (5.8 versus 13.2 months, p = 0.018). In the multivariate analysis, the NLR, patient age, and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.01, p = 0.030; hazard ratio 3.10, p = 0.029; hazard ratio 12.38, p = 0.001, resp.). Conclusions. NLR might be a useful prognostic biomarker in mCRPC patients treated with CBZ.

DOI： 10.1155/2017/7538647

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ijscr.2016.11.042

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：医学図書出版(株)  

精巣上体原発の線維性偽腫瘍は陰嚢内腫瘍の中で非常に稀な腫瘍である。患者は45歳男性で右陰嚢内腫瘤を主訴に来院した。陰嚢部超音波検査では精巣上体に境界明瞭で石灰化を伴う腫瘤を認めた。術中所見で精巣上体に限局した腫瘍であったため、精巣上体摘除術のみを施行した。病理検査の結果、精巣上体原発の線維性偽腫瘍の診断となった。術後18ヵ月経過するが、再発は認めていない。(著者抄録)

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会  

(症例1)31歳女性。妊娠19週時に高血圧を指摘され、精査にて左副腎腫瘍を認めた。血中・尿中カテコラミンが高値を示し、褐色細胞腫と診断した。ドキサゾシン4mg/日内服で血圧はコントロール良好であり、妊娠34週で帝王切開にて分娩した。出産2ヵ月後に後腹膜腔鏡下副腎摘除術を施行した。術後血圧は安定して経過している。(症例2)31歳女性。妊娠初期より動悸・頭痛を認め、妊娠29週で症状増悪し、血中・尿中カテコラミン高値とMRIで下大静脈背側に腫瘍を認め、異所性褐色細胞腫と診断された。ドキサゾシン4m/日、ラベタロール塩酸塩200mg/日にて血圧管理を行い、妊娠35週で帝王切開にて分娩した。出産1ヵ月後に開腹後腹膜腫瘍切除術を施行した。術後は降圧薬内服せず血圧は安定して経過していたが、術後7年後に同部位に再発を認め、再び開腹後腹膜腫瘍切除術を施行した。その後、再発無く経過している。妊娠中に発見された褐色細胞腫の本邦報告例は少なく、母児ともに高い死亡率を示すとの報告もあるが、2例とも術前に十分な血圧管理を行い、二期的に腫瘍摘出術を施行することで母児ともに良好な経過を得た。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01175&link_issn=&doc_id=20161109390006&doc_link_id=1390001205074827520&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001205074827520&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate. A 73-year-old male was referred to our hospital for the further examination of an elevated prostate-specific antigen level of 23.4 ng/mL. Radical prostatectomy (RP) was performed based on the diagnosis obtained by a prostate needle biopsy. The RP specimen revealed ductal adenocarcinoma of the prostate with positive capsular penetration. We herein report a rare case of ductal adenocarcinoma of the prostate.

DOI： 10.1159/000453448

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

A 36-year-old male was referred to our department for further examination of asymptomatic gross hematuria emanating from a bladder tumor. Cystoscopy revealed a broad-based tumor 40 mm in diameter. Urinary cytology was negative. Preoperative magnetic resonance imaging suggested a muscle invasive tumor. Transurethral resection was performed, and the pathological findings revealed an inflammatory myofibroblastic tumor. We herein report a rare case of bladder inflammatory myofibroblastic tumor.

DOI： 10.1159/000449372

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: The neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response, has been demonstrated to correlate with patient outcomes for various solid malignancies. We investigated the utility of the pretreatment NLR as a prognosticator in patients who presented with penile cancer. Methods: A total of 41 patients who underwent complete blood count with differential and subsequent radical penectomy from 1988 to 2014 were analyzed. We assessed the correlation between the NLR and the prognosis of penile cancer. Results: The median and mean (± SD) NLRs in 41 penile cancer patients were 3.42 and 5.03 ± 4.99, respectively. Based on the area under receiver operator characteristic curve, the cut-off value of NLR was determined to be 2.82. Patients with a high NLR (≥2.82) showed a significantly poorer cancer-specific survival (p = 0.023) than those with a low NLR. Conclusions: The pretreatment NLR may function as a biomarker that precisely predicts the prognosis in patients with penile cancer.

DOI： 10.1186/s12885-016-2443-6

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

Hyponatremia is one of the common electrolyte disorders associated with cisplatin (CDDP) administration. We report here two cases of hyponatremia associated with CDDP. Case 1: A 75-year-old man with urothelial carcinoma of bladder (CT3N1M0) underwent neoadjuvant chemotherapy with CDDP and gemcitabine. He lost consciousness on the eighth day after the chemotherapy. Blood tests showed severe hyponatremia (Na 113 mEq/1), low plasma osmolality and high level of plasma vasopressin. Urine tests showed low osmolality. These findings were consistent with the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH). His consciousness level was improved after saline infusion and fluid restriction. Case 2: A 54-year-old man with penile cancer (cT3N2M0) underwent neoadjuvant chemotherapy with CDDP, paclitaxel and fluorouracil. He lost consciousness on the seventh day after the chemotherapy. Blood tests showed hyponatremia(Na 121 mEq/1) with renal dysfunction. Wc concluded that the hyponatremia is due to the renal salt wasting syndrome (RSWS) based on renal dysfunction and high urinary sodium excretion. His consciousness level was improved after saline infusion. Although it is difficult to distinguish between SIADH and RSWS, correct evaluation is necessary for appropriate management of hyponatremia after CDDP administration.

DOI： 10.14989/ActaUrolJap-62-7-361

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例1(75歳男性)。進行膀胱癌に対する術前化学療法としてGC療法(gemcitabine+CDDP)を開始したところ、第8病日目より高度な低Na血症を呈した。一方、Na排泄亢進も認められたが、腎機能障害は認めず、甲状腺ホルモン、コルチゾール値は正常値で、ADHは測定感度以下であったことから、SIADHと診断された。以後、生理食塩水とNaCl製剤による補正を行った結果、第10病日目に低Na血症が改善後、2コース目よりはgemcitabine+nedaplatin療法へ変更し、3コース目まで施行後、膀胱全摘術を行った。症例2(54歳男性)。陰茎癌に対する術前化学療法としてTPF療法(CDDP+paclitaxel+fluorouracil)を施行したところ、第7病日目に高度な低Na血症を呈した。起立性低血圧、腎機能低下などの脱水所見とNa排泄亢進を認めたことから、RSWSと診断された。以後、Na補充と脱水補正を開始した結果、第11病日目に全身状態は改善、2コース目よりはCDDPを減量したが低Na血症の再現はなく、3コース目まで施行後、陰茎部分切除術+鼠径リンパ節郭清術を施行した。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01269&link_issn=&doc_id=20160824420004&doc_link_id=1390290699733438976&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390290699733438976&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

A 66-year-old male was referred to our hospital for further examination of a scrotal mass. Because of the risk of testicular cancer, we first clamped the vessels as a course of higher orchiectomy. Then, we approached the tumor through the scrotum and successfully resected it while preserving the testis. A histopathological diagnosis revealed an epidermal cyst. We herein report a rare case of an intrascrotal epidermal cyst successfully treated while preserving the testis.

DOI： 10.1159/000445826

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Language：English   Publisher：KARGER  

DOI： 10.1159/000442895

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Invasive urothelial carcinoma, lymphoma-like/plasmacytoid variant, is a rare histological type of bladder cancer similar to plasma cells and is an aggressive variant of urothelial carcinoma associated with a poor prognosis. Case presentation: A 41-year-old Asian man was referred to our hospital due to macroscopic hematuria. Cystoscopy detected a non-papillary tumor, and a transurethral resection of the bladder tumor revealed pT1N0M0 bladder cancer. A pathological examination showed high-grade invasive urothelial carcinoma and a component of signet ring cell carcinoma. A follow-up of the transurethral resection with radical cystectomy was carried out, and a pathological examination showed infiltrating urothelial carcinoma, with partial features of the plasmacytoid variant. We added chemotherapy treatment with gemcitabine and cisplatin for two cycles. Our patient has been free from recurrence for 2 years. Conclusions: We herein report the case of a patient with a plasmacytoid variant of urothelial carcinoma controlled with radial cystectomy and subsequent chemotherapy.

DOI： 10.1186/s13256-016-0806-x

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

(Introduction) A pheochromocytoma diagnosed during pregnancy is rare, and also its fetal and maternal mortality is high if undiagnosed. We report two cases with successful pregnancy outcome with pheochromocytoma. (Case 1) A 31-years-old previously healthy woman presented at 19 week period of gestation with high blood pressure. High urine catecholamine level and a left adrenal mass recognized by magnetic resonance imaging (MRI) confirmed adrenal pheochromocytoma. The patient had good blood pressure control after we started doxazosin 4 mg daily, and Caesarean section was performed at 35 week period of gestation. Two months after delivery, laparoscopic adrenalectomy was performed and she was discharged in the absence of hypertension. (Case 2) A 31-years-old previously healthy woman presented at 29 week period of gestation with exacerbation of headache and palpitation. High urine catecholamine level and a mass recognized close to the inferior vena cava by MRI confirmed extraadrenal pheochromocytoma. The patient had good blood pressure after we started doxazosin 4 mg daily and labetalol hydrochloride 200 mg daily. Caesarean section was performed at 35 week period of gestation. One month after delivery, laparotomic resection of the tumor was performed. Seven years later, hypertension reoc-curred and there was an extraadrenal pheochromocytoma recurrence. We had a laparotomic resection for the recurrent tumor, and now she is in the absence of hypertension. (Conclusion) Pheochromocytoma should be considered as a differential diagnosis in a case of high blood pressure occurred during pregnancy. Early detection and appropriate treatment is crucial to reduce fetal and maternal mortality.

DOI： 10.5980/jpnjurol.107.245

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：HINDAWI LTD  

Introduction. The neutrophil-to-lymphocyte ratio (NLR), which can be easily calculated from routine complete blood counts of the peripheral blood, has been suggested to serve as a prognostic factor for some solid malignancies. In the present study, we aimed to determine the relationship between NLR in prostate cancer patients undergoing radical prostatectomy (RP) and their prognosis. Materials and Methods. We assessed NLR in 73 men (patients) who received RP for their prostate cancer. We also performed immunohistochemistry for CD8 and CD66b in a separate set of RP specimens. Results. The median NLR in the 73 patients was 1.85. There were no significant correlations of NLR with tumor grade (p = 0.834), pathological T stage (p = 0.082), lymph node metastasis (p = 0.062), or resection margin status (p = 0.772). Based on the area under the receiver operator characteristic curve (AUROC) to predict biochemical recurrence after RP, potential NLR cut-off point was determined to be 2.88 or 3.88. However, both of these cut-off points did not precisely predict the prognosis. There were no statistically significant differences in the number of CD66b-positive neutrophils or CD8-positive lymphocytes between stromal tissues adjacent to cancer glands and stromal tissues away from cancer glands and between different grades or stages of tumors. Conclusions. There was no association between NLR and biochemical failure after prostatectomy.

DOI： 10.1155/2016/6197353

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

The patient was a 33-year-old man attending the infertility clinic with primary infertility of 3 years duration. The semen examination showed oligozoospermia and suspected primary male infertility. He had a history of chronic sinusitis and respiratory disease. His chest X-ray showed dextrocardia. Abnormality of the ultrastructure of the cilia of the tract epithelium was found by electron microscopy, and further examination revealed bronchoectasis. We gave him a diagnosis of Kartagener syndrome from these findings. Kartagener syndrome consists of bronchiectasis, sinusitis and situs inversus and is considered a form of primary ciliary dyskinesia (PCD). PCD is also a cause of motor impairment of sperm flagella. This case had successful in-vitro fertilization pregnancy with spermatozoa from the patient.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

This study included 10 patients who had developed mumps orchitis previously and had visited our hospital from January 1997 to November 2007. The present illness, testicular volume and semen analysis of 7 of these patients were retrospectively investigated. Semen analyses and pregnancy statuses were followed up over time. The mean age of the 7 patients was 33 years (range, 21-43 years). Four patients had unilateral (right side) orchitis, and three had bilateral orchitis. In the unilateral orchitis group, 1 patient had an atrophic testis. Findings of semen analysis were severe oligozoospermia in three and mild oligozoospermia in one. None of the patients in the bilateral orchitis group, had atrophic testes. Findings of semen analysis were azoospermia in one and severe oligozoospermia in two patients. Findings of semen analysis in most patients improved gradually, and wives of 2 patients eventually achieved pregnancy. Dysfunction of seminiferous tubules in the diseased testis is thought to be reversible when treated adequately in the initial phase. In the patients not conceiving successfully, testicular sperm extraction (TESE) and assisted reproductive technique (ART) are thought to be effective ways to achieve pregnancy.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

This study included 10 patients who had developed mumps orchitis previously and had visited our hospital from January 1997 to November 2007. The present illness, testicular volume and semen analysis of 7 of these patients were retrospectively investigated. Semen analyses and pregnancy statuses were followed up over time. The mean age of the 7 patients was 33 years (range, 21-43 years). Four patients had unilateral (right side) orchitis, and three had bilateral orchitis. In the unilateral orchitis group, 1 patient had an atrophic testis. Findings of semen analysis were severe oligozoospermia in three and mild oligozoospermia in one. None of the patients in the bilateral orchitis group, had atrophic testes. Findings of semen analysis were azoospermia in one and severe oligozoospermia in two patients. Findings of semen analysis in most patients improved gradually, and wives of 2 patients eventually achieved pregnancy. Dysfunction of seminiferous tubules in the diseased testis is thought to be reversible when treated adequately in the initial phase. In the patients not conceiving successfully, testicular sperm extraction (TESE) and assisted reproductive technique (ART) are thought to be effective ways to achieve pregnancy.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

Introduction: Retroperitoneal tumor is often seen in urology clinical practice. To diagnose the tumor, tumor specimens must be obtained. However, in some cases, the tumor is penetrated by vessels around the ureter, and it may be difficult to detect the optimal spot for obtaining a specimen, even when performing open surgery. Case Presentation: A 53-year-old male patient was referred to our hospital for further examination of left back pain due to hydronephrosis. Enhanced computed tomography demonstrated ureter stenosis in front of the ilium, which was surrounded by a retroperitoneal tumor. The tumor was penetrated by blood vessels
therefore, we performed an open surgical biopsy on the suspicion of a retroperitoneal tumor using ureteroscopic assistance. The diagnosis of idiopathic retroperitoneal fibrosis was made according to the biopsy. Conclusion: We herein report the first case of a ureteroscopy-assisted biopsy for the pathological diagnosis of a retroperitoneal tumor.

DOI： 10.1159/000437049

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

前立腺肥大症と診断した50歳以上、IPSS(International Prostate SymptomScore:国際前立腺症状スコア)8点以上かつQOLスコア4点以上の21症例を対象とした。ナフトピジル75mg/日を経口投与し、投与後1、2、3および14日目でのIPSS、QOLスコア、OABSSを投与前と比較し評価した。総IPSSは投与後2日目で有意なスコアの低下を認め、さらに投与後14日目で最大効果発現を示した。IPSS蓄尿症状スコアにおいても同様の傾向が認められた。安全性については、21例中1例に動悸が出現したが、症状は軽度であり継続投与可能であった。ナフトピジル75mg/日は早期、特に2日目から症状の改善を認め、前立腺肥大症に伴う自覚症状に対し有用であった。また、その安全性も確認された。(著者抄録)

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

A 73-year-old male was referred to our department for further treatment of a right retroperitoneal tumor. Contrast CT showed a tumor mass measuring 33 × 26 mm in size with poor contrast enhancement. Because we were unable to rule out tumor malignancy, we planned an operation. The tumor was easily separated and removed without nephrectomy. Histological study revealed a schwannoma. It is rare for this kind of tumor to arise from the retroperitoneum (approximately 0.7% of all cases), in particular at the renal hilum. We herein report a rare case of retroperitoneal schwannoma arising from the renal hilum.

DOI： 10.1159/000440612

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 43-year-old man came to our clinic complaining of infertility and semen analysis showed azoospermia. Analysis of chromosomes showed a mosaic 45, XO/46, X, +marl/46, X, +mar2 karyotype, and the marker chromosomes were considered to be two kinds of ring Y chromosomes. Y chromosome microdeletion analysis showed partial deletion of Azoospermie Factor (AZF) a, and complete deletion of AZFb and AZFc. The patient gave up having a child because these results indicated that no sperm would be collected even if Testicular Sperm Extraction (TESE) were performed.

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：医学図書出版(株)  

結節性硬化症(TSC)患者には高頻度に腎血管筋脂肪腫(AML)が合併する。この腫瘍は無症状で進行し、後腹膜腔への出血や腎機能障害などの重篤な障害を生じる。症例は37歳、女性。TSCと診断を受けており、これまでに両腎巨大AMLからの出血を繰り返していた。AMLのコントロール目的でEverolimusを投与。1年以上持続する腫瘍の縮小および出血の消失を認めたのでここに報告する。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

We investigated the incidence of inguinal lymph node metastasis in 66 penile cancer patients with no palpable or visibly enlarged inguinal lymph nodes (cNO). Median followup interval was 35.7 months. During follow up, 14 patients (21.2%) had inguinal lymph node metastasis and 6 patients died of cancer. Five-year disease-free survival was 77.3%. Univariate analysis demonstrated that local tumor staging (T), differentiation, lymphovascular invasion (LVT), and tumor infiltration pattern (INF, Yamamoto-Kohama grading system) were associated with the incidence of inguinal lymph node metastasis. Multivariate analysis demonstrated that only LVI was associated with incidence of inguinal lymph node metastasis (p = 0.008, Hazard ratio 17.947). According to EAU risk classification, the incidence of inguinal lymph node metastasis in the low-risk group, intermediate risk group and high-risk group was 12.0, 17.6 and 55.6%, respectively. In conclusion, LVI is an independent prognostic factor for inguinal lymph node metastasis in cNO penile cancer. Furthermore, EAU risk classification is valid judging from our cases and in incidence of inguinal lymph node metastasis. Either sentinel node biopsy or inguinal lymph node dissection is recommended in high and intermediate risk patient.

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

It is very important to share patient information because home patient care involves several different specialties of care. We introduced Cybozulive®, a cloud-based free groupware, for 14 terminal-stage patients with urological cancer to share information among doctors and co-medical staff. This system enables access to patient information regardless of time and place. Of the 14 patients (mean age 74.4 years), 11 died of cancer. The average period in which Cybozulive® was used for the patients was 210 days. The average number of entries to the electronic bulletin board in this period was 88.4. We were able to obtain more information about the patients from the website. There was no difference in the average number of times that the patient consulted the out patient clinic before and after the introduction of Cybozulive® (before 7.0
after 6.3). After introduction of this system, eleven patients were hospitalized in our department 21 times. Eighteen of these 21 times, since we had acquired patient information from the website beforehand, there was a quick response for management of the emergency admission. This system could be used to construct a network for home care and may be helpful for sharing patient information in home care.

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

54歳男性。陰茎包皮の腫瘤を触知し放置していたが、前医での生検で陰茎癌(高分化扁平上皮癌)と診断され、今回、手術および化学療法の可能性を検討に著者らの施設へ紹介となった。骨盤部MRIでは陰茎腫瘤は認められるものの進達度は不明であった。だが、右鼠径部には33×27×42mm、右閉鎖神経領域には30×16×31mmのリンパ節腫大がみられ、TxN3M0の診断となった。以後、海外では有効報告があるTPF(Pacrlitaxel、Cisplatin、5-Fluorouracil)療法を行なうにあたり、患者へインフォームドコンセントを十分に行い、同意を得たあと3コース施行、終了時のMRIでは右鼠径部リンパ節は82%、右骨盤内リンパ節は73%縮小が認められた。そこで、次いで陰茎部分切除術+両側鼠径リンパ節郭清術+両側骨盤内リンパ節郭清術を施行した。その結果、患者は術後1ヵ月目にTPF療法を2コース施行したが退院でき、目下も明らかな転移や再発は認められていない。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01269&link_issn=&doc_id=20140313410009&doc_link_id=1050564285742351872&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050564285742351872&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例は40歳女性で、発熱・体重減少・左腰背部痛を主訴とした。腹部造影CTで左腎に一部淡い造影効果を伴う3cm大の腫瘤を認めた。リンパ節転移は認めず、骨シンチグラフィでも転移性病変を疑わせる異常集積像は認められなかった。以上より、腎細胞癌cT1aN0M0 stage 1と診断し、腹腔鏡下根治的左腎摘除術を施行した。術後も発熱が遷延し、CRP高値が持続したため抗菌薬を継続したが解熱せず、CRP・アルカリホスファターゼともに上昇が続いた。FDG-PET/CTと脊椎MRIを施行し、FDG-PET/CTで頸椎・胸椎・腰椎・胸骨・両側骨盤骨など、全身の骨に多数のFDG集積、脊椎MRIにて胸腰椎にび漫性病変を認めた。左腸骨より骨生検術を施行したところ、骨梁間に淡明な胞体をもつ異型細胞が浸潤しており、腎細胞癌の骨梁間型骨転移と診断した。temsirolimus投与を開始し、ゾレドロン酸を併用し、全7コース施行するも全身衰弱が増強し、次第に病状が悪化し永眠された。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01269&link_issn=&doc_id=20140207400006&doc_link_id=1050282810760040576&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050282810760040576&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：UROL & NEPHROL RES CTR-UNRC  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a case of renal cell carcinoma with intertrabecular vertebral metastases detected by F-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI). The patient was a 40-year-old female, referred to our hospital for fever of &gt
38°C, and loss of body weight. Examination showed anemia and elevated C-rcactive protein (CRP). Abdominal enchanced CT showed a mass 3 cm in diameter, located on left kidney. She was diagnosed with left renal cell carcinoma (cT1aNOMO). Laparoscopic radical nephrectomy with a transabdominal approach was performed. Histological findings showed clear cell renal cell carcinoma G2 &gt
G3. Although after operation, she presented with fever of &gt
38°C, anemia, and elevated CRP and alkaline phosphatase. Systemic bone scan could not detect any bone metastases, but FDG-PET/CT and lumber MRI revealed cancer invasion to the bone of the whole body. Histological findings at bone biopsy showed clear cell carcinoma infiltrating the marrow space. We diagnosed the case as bone metastases of intertrabecular vertebral type. She was treated with temsirolimus, but died about five months after her first visit. Intertrabecular vertebral metastases that infiltrate the marrow space without trabecular bone alteration are not visible on radiographs or bone scans. FDG-PET/CT and MRI are more useful for diagnosis of intertrabecular vertebral metastases such as in this case.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

We investigated 470 male patients who came to the Reproduction Medical Center of Yokohama City University Medical Center complaining of infertility between April 2, 000 and August 2013. We analyzed the chromosomes of 90 patients whose sperm concentration was below 1.0 × 107/ml. Nineteen of the 90 (21.1%) patients showed sex chromosomal anomalies including 12 Klinefelter syndrome (47, XXY or 46, XY/47, XXY), Robertsonian translocation, 2 autosome-autosome translocation, Y-autosome translocation, 46, X with marker chromosome (46, Xmar+), XX male and Y chromosome macrodeletion (46, XYq-). While patients with chromosomal abnormalities except XX male or some of 46, XYq-may succeed in reproduction using testicular sperm extraction- intracytoplasmic sperm injection, we need to inform the patients about the risks of chromosomal abnormalities in the resulting fetus.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 54-year-old male was introduced to our hospital in January 2012 for surgical treatment and chemotherapy. The pathological examination revealed well differentiated squamous cell carcinoma of the penis. Computed tomography and magnetic resonance imaging indicated right inguinal and pelvic lymphadenopathy. We diagnosed the tumor to be unresectable radically and administered paclitaxel, cisplatin and 5-fluorouracil (TPF) as neoadjuvant chemotherapy. After 3 courses of chemotherapy, the size of lymphadenopathy had become small enough to allow curative surgical treatment. Partial penectomy and lymph node dissection were performed after neoadjuvant chemotherapy. For 12 months after this radical treatment, the patient has been healthy with no local resurrence and no distant metastatic lesion. TPF chemotherapy for unresectable nodal metastasis from squamous cell carcinoma of penis was suggested to be effective.

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Our patient was a 31-year-old man who presented with right flank pain. Computed tomography revealed multiple tumors in the liver and lungs, with marked elevation of serum human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels. In addition, no testicular abnormalities were detected by palpation or ultrasonography. On the bases of these results, the patient was diagnosed with extragonadal germ cell tumor and was therefore started on chemotherapy with bleomycin, etoposide, and cisplatin (BEP). However, the result of a subsequent blood test showed marked pancytopenia at the initial stage of treatment. We speculated that the cause of anemia was not only bone marrow suppression but also intratumoral hemorrhage, collectively termed choriocarcinoma syndrome. After conservative treatment involving blood transfusion and administration of granulocyte colony-stimulating factor, he recovered. After several chemotherapy sessions, the levels of all tumor markers returned to normal. Finally, the patient underwent hepatectomy for residual tumors
but, the resected specimen showed no viable cancer cells. Currendy, the patient is free from disease since the last chemotherapy session, administered 5 months ago.

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会  

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Language：Japanese   Publisher：医学図書出版(株)  

2000年4月から2010年4月までの10年間に当院にて高位精巣摘除術を行った精巣胚細胞腫瘍症例69例に対し臨床的検討を行った。Seminomaが42例、Nonseminomatous germ cell tumor(NSGCT)が27例であった。Seminoma症例は再発および癌死例はなく、NSGCTでは5年生存率は90.4%、5年非再発率は72.6%と諸家の報告とほぼ同様だった。NSGCT stage Iではサーベイランス群の半分が再発しており、サーベイランスとする場合は厳重な観察が必要と考えられた。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 46-year-old man complaining of infertility was referred to our hospital. He was diagnosed with oligozoospermia, asthenozoospcrmia and hyperprolactincmia probably induced by sulpiride for depression, because semen quality gradually improved after cessation of sulpiride administration. Five months after the cessation, his serum prolactin level declined to the normal level, and his wife achieved spontaneous pregnancy.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Purpose: Azoospermia is a common side effect of chemotherapy. Although most patients restore spermatogenesis overtime, the exact time course has not been well described. We analyzed the recovery of spermatogenesis in testicular cancer patients following chemotherapy. Patients and Methods: 49 patients, consisting of 45 treated with a bleomycin, etoposide and cisplatin (BEP) regimen and 4 with high-dose chemotherapy, were followed up with occasional semen analyses. The primary endpoint of this study was the confirmation of motile spermatozoa in the patients' semen. Results: Among 45 patients treated with BEP, 44 recovered spermatogenesis. The recovery of spermatogenesis was delayed depending on the increase in BEP cycles. In groups of patients who received 1-2, 3 and 4 cycles, the recovery rates of spermatogenesis within 2 year were 83.3, 80.0 and 66.7%, respectively. In the group with 5-6 cycles of BEP, re-spermatogenesis was significantly delayed and no patients re-established spermatogenesis within 2 years. The patients' age and semen parameters before chemotherapy were not useful as predictive factors for the recovery of spermatogen-esis. Conclusion: The recovery of spermatogenesis was rather fast and was often observed as early as several months after BEP treatment when the number of cycles was &lt;4. Copyright (C) 2013 S. Karger AG, Basel

DOI： 10.1159/000351189

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：John Wiley and Sons Ltd  

Empty follicle syndrome (EFS) has been defined as a condition where no oocytes can be retrieved for in vitro fertilization (IVF) even though ultrasound findings and estradiol (E2) levels suggest the presence of potential follicles. The EFS is a rare condition with an incidence of 0.5-7 % of women undergoing IVF treatments. Although there are many hypotheses as to the cause of EFS, including advanced ovarian age, drug-related problems, and dysfunctional folliculogenesis, its cause remains unknown. A 37-year-old woman with endometriosis and a 5-year history of primary infertility underwent IVF treatment for 4 cycles. No oocytes were retrieved in 2 cycles and no fertilized eggs were obtained in the other 2 cycles. We assumed that endometriosis adversely affected folliculogenesis and fertilization. Aspiration of an endometrial cyst in the right ovary and subsequent administration of oral contraceptives resulted in successful folliculogenesis and fertilization. Thereafter, she conceived and delivered a 2,662 g female infant at 38 weeks of gestation. Here, we report a case of EFS who conceived in the 5th IVF cycle after aspiration of an endometrial cyst. We assumed that endometriosis might have been involved in the dysfunction of folliculogenesis and EFS. © 2013 Japan Society for Reproductive Medicine.

DOI： 10.1007/s12522-013-0146-0

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Language：Japanese   Publisher：医学図書出版(株)  

症例は12歳男児。外傷性尿道球部完全断裂のため当科受診し、受傷後6ヵ月時に経会陰式尿道端々吻合術を施行した。術後経過は良好であったが、徐々に尿勢低下を認め、術後6ヵ月時に吻合部の膜様狭窄に対し内尿道切開術を施行した。しかし、3ヵ月後に再狭窄を認めたため、全身麻酔下に尿道バルーン拡張術を施行した。その後、再狭窄は認めず、術後3年経過した現在も尿勢は保たれており残尿もなく、外来経過観察中である。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

平成15年から平成23年までの間に当院で手術を施行した陰茎癌の症例14例を対象に臨床的検討を行った。平均年齢は67.8歳であり、腫瘍径の平均は4.8cmであった。StageはIが9例、IIが2例、IIIが0例、IVが3例であった。平均観察期間は67.4ヵ月で、観察期間中に14例中5例で再発またはprogressionをきたし、3例が癌死した。またadjuvant chemotherapyとしてMPB(MTX、CDDP、BLM)を5例に施行した。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 75-year-old man with advanced bladder cancer (cT4N1M0) received three courses of systemic chemotherapy with Methotrexate, Epirubicin and Nedaplatin (MEN). His metastatic lymph node completely disappeared. We performed total cystectomy. Three months after the surgery, he complained of neck pain and nausea. Brain magnetic resonance imaging (MRI) revealed a 3 cm tumor in his right cerebella and a 5 mm tumor in left parietal lobe. He underwent surgical resection of the right cerebellar tumor and a gamma knife therapy for the left parietal tumor. Pathological diagnosis was metastatic urothelial carcinoma. We performed three additional courses of chemotherapy of MEN. He has been well without local recurrence or distant metastasis for 18 months.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

To investigate the safety and efficacy of a maintenance regimen of bacillus CalmetteGurin therapy including 6-week induction and 2-week maintenance instillation for patients with recurrent or multiple Ta, T1 tumors or carcinoma in situ of the urinary bladder.
This study was performed as single-arm multi-institutional study. The enrolled patients had been diagnosed with urothelial carcinoma of the bladder, including the presence of at least two bladder tumors, single tumors recurring within 12 months of follow-up, any Grade 3 Stage Ta or T1 tumor, and primary or recurrent biopsy proven carcinoma in situ. Patients received 81 mg intravesical bacillus CalmetteGurin (Connaught strain). The instillation was repeated once a week for another 5 weeks, followed by once a week for 2 weeks at months 3, 6, 12, 18, 24, 30 and 36, for a total of 20 instillations in 3 years.
From 28 hospitals, 202 patients were registered. A total of 186 patients matched the inclusion criteria: 139 patients in the Ta/T1group and 47 patients in the carcinoma in situ group. At the 4-year median point of follow-up, recurrence-free survival rates in the Ta/T1 group and the carcinoma in situ group were 76.7 and 77.7, respectively. Completion rates for maintenance therapy in both groups at months 3, 6, 12, 24 and 36 were 81.7, 68.9, 58.1, 42.5 and 35.0, respectively. Common toxicities were pain on urination, urinary frequency and gross hematuria. There was no treatment-related death.
This regimen may be feasible in patients with Ta/T1 tumor or carcinoma in situ; however, future Phase III randomized study is needed to determine whether this regimen would be truly safe and effective compared with 3-week maintenance regimen.

DOI： 10.1093/jjco/hys097

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Language：English   Publishing type：Research paper (scientific journal)  

Objective: Repeat transurethral resection (ReTUR) is an effective treatment for non-muscle-invasive bladder cancer (NMIBC) to prevent disease recurrence or progression. It also has an important role in stratifying patients according to histopathological results. Therefore, the end point of ReTUR should be considered in a treatment algorithm. We evaluated positive ReTUR to define its role in a treatment algorithm for NMIBC. Materials and Methods: A second TUR was performed in 111 patients between July 2006 and February 2010. A third TUR was performed in 31 patients with T1/a/is tumors at the second TUR. The incidence of residual disease was calculated according to the NMIBC risk levels proposed by the International Bladder Cancer Group. We used ReTUR as a general term to indicate second and third TURs. Results: Residual disease at the second TUR was detected in 51% of the patients
it was observed in 17%, 45%, and 65% patients in the low-, intermediate-, and high-risk disease groups, respectively (P = 0.01). Residual disease at the third TUR was detected in 48% patients
it was observed in 18% and 65% patients in the intermediate- and high-risk disease groups, respectively (P = 0.06). Conclusion: The incidence of residual disease correlated with the risk levels for NMIBC. In the intermediate-risk disease group, nearly complete resection was accomplished after the third TUR. However, in the high-risk disease group, a high incidence of residual disease was identified even after the third TUR. Our results provide important data that may be useful in establishing an end point in a treatment algorithm for NMIBC.

DOI： 10.4103/0970-1591.102697

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 40-year-old man was referred to our hospital with a 12-year history of infertility. He was a welldeveloped male weighing 78 kg with a height of 171 cm. Physical examinations revealed male habitus with normal adult pubic and axillary hair. The penis, epididymides, spermatic cords and prostate were normal. The right testis was about 15 ml in volume and left ne was approximately 12 ml, respectively. Repeated semen analyses showed azoospermia except for only one time when 4 immotile sperm were detected. The plasma levels of lactate hydrogenase, follicle stimulating hormone prolactin and testosterone were within normal limits. Chromosome analysis of peripheral lymphocytes revealed a balanced reciprocal translocation between the short arm of chromosome 12 and the long arm of the Y chromosome (46, X, t (Y
12) (q12
p13.3)). We performed microdissection testicular sperm extraction and retrieved 11 spermatozoa (10 progressive motile). Seminiferous epithelium showed maturation arrest at the stage of spermatid. Mean Johnsen's score count was 6. The etiology and clinical features of this rare disease were briefly discussed.

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

アンドロゲン除去症候群(Antiandrogen withdrawal症候群:以下AWS)を確認することは進行前立腺癌に対して有用な治療の一つである。一般的にAWSの継続期間は限定的であるが、長期間AWSが持続した3例を経験したので報告する。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

われわれは2例の精巣類上皮嚢胞(Epidermoid cyst)を経験した。症例は59歳、60歳男性。精巣腫瘍の診断で高位精巣摘除術施行し病理組織所見にて精巣Epidermoid cystと診断された。2例とも以後再発認めず経過良好である。精巣Epidermoid cystは精巣腫瘍全体の約1%を占め比較的稀な良性腫瘍で精巣温存術が可能との報告もあるが、奇形腫成分が含まれていないか注意が必要である。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

症例は8歳の男児。過去に計3回の手術歴を認めた。排尿障害が出現し精査したところ、膀胱憩室を認め、切除術を施行した。術中膀胱内操作時に、ラテックス製手袋によるアナフィラキシーショックを起こし、血圧、酸素飽和度などの急激な低下を認めた。エピネフリン、ステロイド投与後、手術再開可能となり、ラテックスフリーの環境とし、手術完遂した。手術歴のある患者では、常にラテックスアレルギーの発生を念頭に置き、対処する必要があると再認識した。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

症例は30歳男性。不妊を主訴に受診され、染色体検査の結果非モザイク型Klinefelter症候群と診断された。MD-TESE施行し6個の精子を採取できた。今後胚移植を行う予定である。Klinefelter症候群は不妊を呈する染色体異常の一つであり治療困難とされていたが、TESE登場以来は良好な精子回収率が報告されている。しかし生まれてくる胎児の染色体異常のリスクについても説明することが肝要である。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 58-year-old man visited our hospital with gross hematuria. Cystoscopy revealed a papillary tumor around the left ureteral orifice. Transurethral resection of bladder tumor (TUR-Bt) was performed and histopathological findings revealed a nested variant of urothelial carcinoma. Computed tomography (CT) revealed no involvement of other organs. Laparoscopic radical cystectomy and orthotopic neobladdcr substitution (Studcr methods) were performed. The histopathological stage was pT3aN0M0. Adjuvant chemotherapy (gemcitabine + cisplatin) was performed. The patient is currently free from disease at five months after the surgery.

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.102.348_3

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.102.460_4

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We retrospectively reviewed 9 patients with squamous cell carcinoma of the penis who were treated with penis preservation between April 1988 and January 2008. Six patients had recurrence and 4 patients died of cancer. Patients treated with penis preservation had a significantly higher. Future studies are needed on a larger number of cases.

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

症例は3歳男児。主訴は陰茎亀頭外尿道口部腫瘤。包茎に対して用手的包皮翻転8ヵ月後に腫瘤が出現し、当院受診。外尿道口周囲に乳頭状腫瘤を認め、尖圭コンジローマと診断した。全身麻酔下にコンジローマ切除術施行。病理組織学的には典型的な尖圭コンジローマの所見であり、DNAアッセイでHPV11型が同定された。術後2ヵ月経過しているが、再発は認めない。なお、感染経路として、包茎治療時の医原性感染が最も強く疑われた。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

An 81-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone as an outpatient. After 4 courses of chemotherapy, he was admitted to our hospital in December 2007 because of general fatigue, appetite loss and erythema of the back of hands and face. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. An 80-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone without admission. After 8 courses of the chemotherapy, appetite loss appeared. In January 2008, medical examinations revealed nails peeling off, facial erythema and erosion of the back of his hands. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. Pellagra, a nicotinic acid deficiency disease, is rarely observed clinically nowadays. However, it may occur in the patients, undergoing chemotherapy without admission.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

To identify the risk factors for developing subsequent bladder carcinoma in patients undergoing surgical management of urothelial carcinoma (UG) of the upper urinary tract, we retrospectively studied 119 (median age 69, 81 males and 38 females) patients who underwent surgical resection at Yokohama Municipal Citizen's Hospital, Yokosuka Kyousai Hospital and Chigasaki Municipal Hospital from August 1980 to September 2006. After a median follow up of 37.7 months, 42 cases (35.3%) developed recurrent bladder cancer and the intravesical recurrence-free survival rate at 5 years (Kaplan-Meier method) was 57.7%. Bladder cancer was significantly more common in patients who had smaller primary tumors (less than 3 cm : p = 0.0444) by univariate analysis. This factor was also identified as independent predictor for the intravesical recurrence by multivariated analysis (p = 0.0495, Hazard ratio 2.099). In 42 intravesical recurrence cases, invasive recurrence was seen in 9 cases (21.4%). Invasive recurrence appeared to occur in the patients who were older and had longer interval by intravesical recurrence.

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Language：Japanese  

The objective of this study was to evaluate the efficacy and safety of low-dose docetaxel, estramustine and dexamethasone combination chemotherapy in patients with hormone-refractory prostate cancer (HRPC). Sixty-nine patients with HRPC were enrolled. Docetaxel was given at a dose of 25 mg/m(2) on days 1 and 8 every 3 weeks, oral estramustine 280 mg twice daily on days 1 to 3 and 8 to 10, and oral dexamethasone 1 mg daily throughout the course. Cycles were repeated every 21 days. Treatment was continued until disease progression or excessive toxicity. Patients were evaluated for response and toxicity. Patients received a median of eleven cycles (range : 1-25). Prostatic-specific antigen (PSA) was decreased greater than 50% in 53 (77%) out of 69 patients and median duration of PSA response was 10.2 months. Median time to progression and overall survival 10.2 and 24 months, respectively. Grade 1-2 fatigue was the most common toxicity observed in 10 (15%) patients. Grade 3-4 toxicities were observed in five (7%) patients (2 thrombosis, 2 bilirubin elevation, and 1 aspartate transaminase/alanine transaminase elevation). Low-dose docetaxel, estramustine and dexamethasone combination chemotherapy is an effective and well tolerated treatment for Japanese HRPC patients.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.101.404_3

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.101.397_1

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Human papillomavirus (HPV) may be carcinogenic effectors in a variety of human lower genital tract malignancies. We evaluated HPV status with respect to clinical and pathological features and prognosis of penile carcinoma. We searched for HPV infected cells (Koilocytosis) within the primary lesion of cancer tissue from 78 patients with penile squamous cell carcinoma. The following variables were recorded: age, tumor size, clinical stage, lymphatic and venous invasion, histologic and nuclear grade, Broders grade, infiltration status, and lymph node and distant metastasis. Koilocytosis were detected 55.1% (43 of 78) of patients. Tumors with Koilocytosis had better differentiation (p = 0.0443) and lower grade (better keratinized) in Broders grading system (p = 0.0116) than HPV negative tumors. No difference was found in the 5-year survival rate (p = 0.5693). Our data suggest that the presence of Koilocytosis does not influence prognosis in penile cancer.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that may often involve organs other than those of the gastrointestinal tract. We investigated retrospectively the frequency, diagnosis and treatment of urinary and male genital complications of CD and UC. From February 1998 to July 2007, 93 patients with CD and 75 patients with UC consulted our department for urinary and male genital complications. Thirty, 19 and 16 of the 93 patients with CD were diagnosed as having fistulas to the urinary and male genital systems, urolithiasis and hydronephrosis, respectively. Fifteen, 14 and 13 of the 75 patients with UC were diagnosed as having urolithiasis, urinary tract infection (UTI) and lower urinary tract symptoms (LUTS), respectively. Fistula to the urinary and male genital systems in CD occurred more often in men. In 22 CD patients who had undergone surgical operation and were definitively diagnosed as fistula, the positive rate of cystogram (CG) was 38.1% (8/21). They presented with pyuria (10 cases), pneumaturia (7), hematuria (7), fecaluria (2) and urorrhea (2). Cystoscopy was performed in 20 patients. Fistula opening in the urinary bladder was found in only 2 patients. Other findings in the bladder were edema (14 cases), redness of mucosa (6) and debris (3). Hydronephrosis in CD occurred in 16 patients. Placing a percutaneus nephrostomy (PNS) or ureteral stent was performed in 11 patients and surgical therapy was performed in 12 patients. Only two of the 34 patients with urolithiasis (CD 19, UC 15 cases) underwent ESWL and/or TUL. Almost all patients with UTI in UC were treated with antibiotics and improved, but one patient died from Fournier's Gangrene due to erirectal abscess.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

We intended retrospectively to investigate whether reactive oxygen species (ROS) levels, detected in whole semen, were correlated with the actual pregnancy rate.
A total of 89 patients with data of ROS in semen, attending our male infertility clinics from April 1994 to June 2000, were evaluated. Semen parameters were determined with computer assisted semen analyzer (CASA) and ROS production levels were measured using a computer-driven LKB Wallac 1251 Luminometer after the addition of 40 mu L of 4 mM luminol at the patients&apos; first visits. All of the participants were inquired about their partners&apos; pregnancies after the mean follow-up of 24.0 months (range 1.4 to 74.1). They were divided into two groups (pregnant group: n = 41, non-pregnant group: n = 48) and their characteristics, semen profiles and integrated ROS levels were analyzed.
There was no difference between the pregnancy rate of ROS detectable cases and negative cases. However, the mean integrated ROS level in detectable cases of the non-pregnant group was significantly higher than that in detectable cases of the pregnant group (115.61 +/- 74.32 mV/30 min/10(6) sperm versus 7.22 +/- 4.69 mV/30 min/10(6) sperm, P = 0.0033). Then, by calculating the receiver operating characteristics curve with 95% confidence intervals, 4.35 mV/30 min/10(6) sperm was considered as a cut-off value of ROS in semen for pregnancy.
These results indicate that (i) highly detectable ROS in whole semen of infertile patients may have implications in their partners&apos; pregnancies and that (ii) detection of ROS in whole semen has a prognostic value for idiopathic male infertility.

DOI： 10.1111/j.1442-2042.2008.02213.x

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Language：Japanese   Publishing type：Research paper (scientific journal)  

To identify prognostic factors influencing survival in transitional cell carcinoma (TCC) of the upper urinary tract, we retrospectively studied 189 (median age 70, 130 males and 59 females) patients who underwent surgical resection at our 3 hospitals from August 1980 to September 2006. After a median follow up of 47.8 months, 45 cases (23.8%) died of cancer and the 5-year and 10-year disease-specific survival rate (Kaplan-Meier method) was 70.5 and 67.1%. Because lymphatic and vascular involvements, pattern of infiltration and location of tumor had loss of data, only the univariate analysis was done. They were observed to be significantly different by the univariate analysis. The significant prognostic factors for survival using Cox-proportional hazard models were tumor stage, tumor grade, lymph node metastasis, and surgical margin status. Adjuvant chemotherapy was not the prognostic factor in our multivariate analysis.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.100.430_3

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.100.368_1

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.100.368_4

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.449_2

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.491_3

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 58-year-old male consulted our hospital because of penile swelling and pain with bilateral inguinal lymphadenopathy. Pathological examination of the penile tumor and right superficial inguinal lymph node biopsy demonstrated moderately differentiated squamous cell carcinoma with lymph node metastasis. We diagnosed the tumor inoperable radically and adjuvant chemotherapy with methotrexate, cisplatin and bleomycin was administered, followed by partial penectomy and left superficial lymphadenectomy. The surgical specimens showed few viable tumor cells. This combination chemotherapy is suggested to be effective for the treatment of advanced penile cancer.

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Language：Japanese  

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Other Link： http://hdl.handle.net/2433/71468

Language：Japanese   Publishing type：Research paper (scientific journal)  

Two cases of renal cell carcinoma presenting with uncontrolled diabetes mellitus are reported. A 61 and 64-year-old women with hyperglycemia were incidentally found to have a right renal tumor. Laboratory investigation of both cases revealed glucose of 324 mg/dl and 357 mg/dl, HbAlc of 9.3% and 8.9%, respectively. Hyperglycemia had been controlled by administration of 25 and 58 units of insulin, respectively. In both cases, after a radical nephrectomy, the diabetic state completely resolved without insulin administration. Immunohistological study revealed the tumor cells positive in one case and negative in the other case for interleukin (IL) 6.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A chromosomal survey using the G-banding technique was performed on 87 subfertile male whose semen analysis demonstrated severe oligospermia and azoospermia at Yokohama City University Hospital between January 1990 and October 2002. Fourteen of these subjects demonstrated major chromosomal anomalies (16.1%). Semen analysis in these cases demonstrated azoospermia, except in one case of autosomal abnormality. Twelve patients showed sex chromosomal abnormalities including 8 Klinefelter syndrome (47XXY) and 2 XX males (46XX) and two patients had autosomal abnormalities. The follicle-stimulating hormone (FSH) value in these patients, except for the two cases of autosomal abnormality and one case of 46XYq-, was much higher than normal. Histological examination was performed in 7 cases. In these cases, intratesticular spermatozoa were seen in only two cases (Klinefelter syndrome case and ring chromosome 21 case). Chromosome studies are important in the evaluation of subfertile patients with azoospermia and severe oligospermia. Because the abnormal genotype could be transferred to the next generation, the importance of chromosome studies before ICSI should be emphasized.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.98.430_1

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

(Purpose) To analyze the characteristics and prognostic factor of penile cancer, we retrospectively reviewed the clinicopathological data of patients with a diagnosis of penile cancer treated. (Patients and methods) The records of 59 patients (median age 66, ranged from 47 to 91) with squamous cell carcinoma of the penis reffered between April 1988 and January 2006 were reviewed. The importance of tumor size and stage, differentiation, type of infiltration, vascular invasion, patient age, lymph node metastasis, distant metastasis and type of therapy were assessed using univariate and multivariate analyses. (Results) After a mean follow up of 37.7 months, 13 cases (22.0 % ) died of cancer and 5-year survival was 67.4%. Multivariate analysis demonstrated that, type of operation (p = 0.0471, Hazard ratio 3.364), vascular invasion (p = 0.0014, Hazard ratio 5.921) were associated with survival. (Conclusion) Vascular invasion and type of operation were related to survival. Our findings indicate that correct pathological diagnosis and appropriate treatment may lead to prolonged survival.

DOI： 10.5980/jpnjurol1989.98.819

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Between January 1989 and March 2002, we treated 299 male bladder cancer patients and 416 prostatic cancer patients. Of these, 17 patients (5.7% of the male bladder cancer patients and 4.1% of the prostatic cancer patients) had double cancer consisting of prostatic cancer and bladder cancer. The mean age at diagnosis of the first and second cancer was 71.6 years and 75.5 years, respectively. Of the 8 patients with synchronous tumors, 3 patients had latent prostate cancer when they underwent total cystoprostatectomy. The mean interval between the first and second cancer was 45.3 months. The mean follow-up period was 84.7 months (ranged from 5 to 324 months) and two patients died of cancer (bladder: 1, prostate: 1). In the literature, the coincidence of bladder cancer and prostatic cancer is the highest in the urological field. In follow up of either of these cancer patients, it is important to be aware of not only progression of the first cancer but also generation of a second cancer.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.97.395_2

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report 3 patients with pulmonary hamartoma, all of whom had undergone nephrectomy for renal cell carcinoma. A lung tumor was detected 2 to 9-months following nephrectomy. Preoperative diagnosis was pulmonary metastasis from renal cell carcinoma and pulmonary tumor resection was performed in each case. There was a 9- to 12-month interval between the detection and resection of the lung tumor. The histological diagnosis of the lung tumor in all three patient was pulmonary hamartoma. Following the resection of the lung tumor, recurrence was not noted in any of the patients.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JOHN WILEY & SONS INC  

BACKGROUND. Sperm cryopreservation before cancer chemotherapy is available for young patients with cancer. However, few patients bank their sperm. The authors evaluated by questionnaire the psychological impact of sperm cryopreservation.
METHODS, The authors cryopreserved the sperm of 111 patients with cancer for free at the Yokohama City University (Yokohama, Japan). For the current study, questionnaires were mailed to 66 patients whose sperm had been cryopreserved. Fifty-one patients (77.3%) with testicular carcinomas (n = 24), leukemia or malignant lymphoma (n = 19), or other cancers (n = 8) answered the questionnaire. The average age at collection and the period of sperm cryopreservation were 30.1 +/- 6.0 (mean +/- standard deviation) and 3.3 +/- 2.2 years, respectively.
RESULTS. Many patients were informed of the deleterious effects of cancer chemotherapy and worried about infertility in the future. However, only half of the patients banked their sperm on their own initiative. Other patients followed their physician's instruction. Eighty percent of patients replied that sperm cryopreservation helped in the battle against cancer. Sperm banking especially was found to encourage every patient who banked sperm on their own initiative. After cancer chemotherapy, 70% of patients wanted to have a child. However, 60% of patients were worried about infertility in spite of having their sperm cryopreserved. No patients wanted to use cryopreserved sperm for fathering children if their spermatogenesis was restored. Sperm cryopreservation invigorated many patients with cancer after cancer treatments. The majority of patients recommended sperm cryopreservation to other cancer patients.
CONCLUSIONS. Sperm cryopreservation encouraged young patients with cancer during and after cancer treatment. It should be recommended for all young patients with cancer. However, sperm cryopreservation did not eliminate their fear of infertility. (c) 2005 American Cancer Society.

DOI： 10.1002/cncr.21185

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An 81-year-old woman consulted us with low abdominal pain. A computed tomography (CT) image showed left hydronephrosis and a mass without calcification at the lower portion of the left ureter. A retrograde urogram showed an irregular filling defect at the lower portion of the left ureter that suggested an obstruction by a malignant ureter tumor. Therefore, total nephroureterectomy was performed. The surgical specimen showed a mass with a membrane, which could be detached easily from the ureter wall. The ureter wall showed hyperkeratosis upon histological examination, and the mass was diagnosed as cholesteatoma.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.96.184_2

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

(Objective) To know the survival and prognostic factors of the patients who received radical cystectomy with or without neoadjuvant cisplatin-based chemotherapy. (Methods) Between 1977 and 2001, 201 patients underwent radical cystectomy at Yokohama City University and Yokosuka Kyosai Hospital whose tumor were clinically diagnosed as locally invasive bladder cancer (T2-4NxM0). Survival rates and 9 prognostic factors (Age, Size, Multiplicity, Type, Grade, p-stage, n, neoadjuvant chemotherapy, adjuvant chemotherapy) were analysed by Kaplan-Meier methods and Cox-proportional hazard model. (Results) The independent prognostic factors of these patients were size, multiplicity, type, grade, p-stage, n, neoadjuvant by univariate analysis. Of these 7 factors, n, neoadjuvant, p-stage and size are significant by multivariate analysis. Survival of the patients who received neoadjuvant cisplatin-based chemotherapy followed cystectomy is better than cystectomy only group by Kaplan-Meier method. (Conclusions) From these rusults, neoadjuvant cisplatin-based chemotherapy play some role for survival of the patients with invasive bladder cancer.

DOI： 10.5980/jpnjurol1989.96.548

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report two cases of retroperitoneal liposarcoma arisen from the perirenal fat tissue, which could not be diagnosed preoperatively. Case 1 is a 58-year-old male. He complained of left flank tumor. Computed tomography and magnetic resonance image showed a mass over 10 cm that contained fat components in the retroperitoneal space. The tumor was resected with left nephrectomy and histological examination revealed well differentiated liposarcoma. As adjuvant therapy, he received chemotherapy and 30 months has passed uneventfully. Case 2 is a 70-year-old male. Screening ultrasonography revealed incidental retroperitoneal tumor. With clinical diagnosis as nonfunctioning adrenal tumor, he received left nephrectomy. The pathological diagnosis was well differentiated liposarcoma, sclerosing type. No adjuvant therapy was performed. He has stopped visiting our clinic due to aggravation of heart disease. The characteristics of the images of the two cases were different despite the histological resemblance. This difference was considered to be due to the difference in the distribution of lipomatous tissue in each patient.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

To examine the incidence of recurrence, progression and survival in patients with grade 3 superficial bladder cancer after transurethral resection (TUR) and adjuvant intravesical instillation of Bacillus Calmette-Guérin (BCG), we retrospectively studied 39 patients with grade 3 superficial bladder cancer. Nineteen patients with high-grade superficial bladder cancer (pTa, pTl) and 5 patients with grade 3 carcinoma in situ (CIS) received intravesical instillation of BCG after transurethral resection of the bladder tumor (BCG group and CIS-BCG group). The Tokyo 172 strain BCG was given for 8 weeks, as a rule, in a dose of 80 mg in 40 ml of saline instilled into the bladder. As a control, 15 patients with grade 3 superficial bladder cancer who did not receive BCG therapy after TUR were compared (non-BCG group). Of the BCG group (n-19), 4 patients (21.1%) had recurrent tumor and 3 had invasive progression after BCG therapy and died as a result of tumor progression, while in the non-BCG group (n = 15), 8 cases (53.3%) developed recurrence, only one case had progression and died of cancer. In the CK-BCG group (n = 5), 3 patients (60.0%) had recurrent tumor and 2 had invasive progression. Univariate analysis (Logrank test) demonstrated that tumor size and adjuvant instillation of BCG were associated with tumor recurrence except for carcinoma in situ, but tumor progression and survival did not differ significantly. Our results suggest that BCG therapy prevents grade 3 superficial bladder cancer (pTl, pTa) recurrence.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 66-year-old man was admitted to our hospital with left flank pain. Drip infusion pyelography (DIP) and abdominal computed tomography (CT) showed urinary extravasation. Magnetic resonance imaging (MRI) and retrograde pyelography (RP) demonstrated stenosis of the ureter. Left nephroureterectomy was performed. Histopathological examination showed poorly differentiated adenocarcinoma, located in the ureteral wall with intact mucosa and adventitia. After the operation, sigmiod colon carcinoma was pointed out by colon fiberscope, and sigmoidectomy was performed.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

To determine whether there was any correlation between recurrence of superficial bladder cancer and the results of urinary cytology examined for 3 consecutive days after transurethral resection of the bladder cancer (TURBT), we retrospectively studied 64 patients with newly diagnosed Ta/T1 transitional cell carcinoma (TCC) of the bladder who had previously undergone TURBT. Urine cytology samples were reported as negative (class I, II) or positive (class III, IV, V). We used the Kaplan-Meier method to calculate the non-recurrence rate, and Cox-proportional hazard models to determine the prognostic significance of clinical and pathological findings. If any sample among the three consecutive cytology examinations was positive, we defined the case as positive. After a mean follow up of 19.5 months, 22 cases (34.4%) demonstrated recurrence probabilities of 24.1% and 42.3%, at 12 and 24 months, respectively. Of the positive cytology group (n=33), 15 patients (45.5%) had recurrent tumor, while in the negative group (n=31), only 7 cases (22.6%) developed recurrence. Multivarite analysis demonstrated that. tumor size (p=0.0022, Hazard ratio 8.9316), result of urine cytology for three consecutive days after TUR (p=0.0051, Hazard ratio 4.5728), and age (p=0.0124, Hazard ratio 3.7652) were associated with tumor recurrence. We suggest that positive results on urinary cytology for three consecutive days after TUR are indicative for tumor recurrence.

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We report a case of squamous cell carcinoma of the ureter. A 62-year-old woman had undergone total cystectomy and ileal conduit because of squamous cell carcinoma of the bladder when she was 44 years old. Seventeen years later, she complained of edema and oliguria. Antegrade pyelography and loopography revealed a left ureteral tumor. She underwent left ureterectomy and extirpation of the conduit. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the ureter, pT2. The patient is alive without recurrence or metastasis in the first year after surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report two cases of XX male with chief complaints of infertility. Physical examination ofboth of both patients aged 42 and 29 demonstrated normal male habitus except for small testes. Semen analyses demonstrated no spermatozoa. Endocrinological examinations showed hypergonadotrophic hypogonadism. Vesiculograms demonstrated normal seminal tracts. Histological examination of their testes did not reveal germ cells
one case lacked seminiferous tubules and there was hyalinization in the seminiferous tubule in another case. Chromosomal analyses of peripheral blood demonstrated 46,XX. The sex-determining region Y gene was positive and DAZ (deleted in azoospermia) gene was negative in both cases.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 34-year-old male visited our department with a chief complaint of infertility, hemospermia and decreasing semen volume. Physical examinations were unremarkable and endocrinological tests demonstrated no abnormalities, however, semen analyses showed a seminal volume of 1.0 ml, many red blood cells and a few motile spermatozoa. MR image revealed a midline cystic mass of the prostate and the vesiculogram confirmed the diagnosis as an ejaculatory duct stenosis due to Müllerian duct cyst. We performed transurethral resection of hemi-verumontanum with testicular biopsy and confirmed recanalization of the seminal tract. His testicular histology showed normal spermatogenesis. Since left epididymitis occurred on the 24th day after the surgery, the patient was given 1.0 g/day of Panipenem. Followed by subsequent right epididymitis occurred, his bilateral epididymitis recovered normal consistency after additional dosing of Isepamicin. Postoperative semen analysis showed a seminal volume of 2.5 ml, sperm concentration of 14.0 × 106/ml, sperm motility of 70.0% and no red blood cells. The pregnancy of his spouse was confirmed 7 months after the surgery.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SOC STUDY REPRODUCTION  

Mammalian male germ cells might be generally thought to have infinite proliferative potential based on their life-long production of huge numbers of sperm. However, there has been little substantial evidence that supports this assumption. In the present study, we performed serial transplantation of spermatogonial stem cells to investigate if they expand by self-renewing division following transplantation. The transgenic mouse carrying the Green fluorescent protein gene was used as the donor cell source that facilitated identification and recollection of colonized donor germ cells in the recipient testes. The established colonies of germ cells in the recipient testes were collected and transplanted to new recipients. This serial transplantation of spermatogonial stem cells repopulated the recipient testes, which were successfully performed sequentially up to four times from one recipient to the next. The incubation periods between two sequential transplantations ranged from 55 to 373 days. During these passages, the spermatogonial stem cells showed constant activity to form spermatogenic colonies in the recipient testis. They continued to increase in number for more than a year following transplantation. Colonization efficiency of spermatogonial stem cells was determined to be 4.25% by using SI/SId mice as recipients that propagated only undifferentiated type A spermatogonia in their testes. Based on the colonization efficiency, one colony-forming activity was assessed to equate to about 20 spermatogonial stem cells. The spermatogonial stem cells were estimated to expand over 50-fold in 100 days in this experiment.

DOI： 10.1095/biolreprod.102.004549

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.94.175_1

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

(Purpose) we report our experience in 10 years of sperm cryopreservation to reveal the present state of the cryopreservation project. (Materials and Methods) 42 germ cell tumor, 110 non-germ cell tumor and 2 non-malignant disease patients who visited our clinic for semen cryopreservation were retrospectively analyzed. (Results) only 7 (20%) out of 35 unilateral testicular tumor patients who had received no chemotherapy met the WHO criteria for sperm concentration and motility. However, there were no patients with azoospermia. Three testicular tumor patients with previous chemotherapy and 4 retroperitoneal germ cell tumor patients had poor sperm concentrations and motilities. Twenty (52%) out of 38 non-germ cell tumor patients without previous chemotherapy met the WHO criteria. In contrast, only 9 patients (13%) met the WHO criteria among 72 patients with previous chemotherapy. Twenty-nine patients (40%) with chemotherapy were azoospermia. Totally, 74 (96%) of 77 tumor patients' semen without chemotherapy and 34 (45%) of 75 with chemotherapy were cryopreserved. Sperm from a patient with testicular torsion were cryopreserved. (Conclusion) most cancer patients without previous chemotherapy, regardless of underlying disease, had abundant motile sperm. However, half of the patients who had received chemotherapy did not have suitable sperm for freezing. It is important to inform young cancer patients of the cryopreservation project immediately after the diagnosis is made.

DOI： 10.5980/jpnjurol1989.94.513

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.93.204_1

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

(Purpose) To assess the effect of high concentration of sodium and potassium ion on the motilities of human sperm following the preservation in electrolyte-free solution. (Patient) Semen samples were obtained from patients attending our infertility clinic. The motilities of their sperm were more than 40%. (Method) Ejaculated sperm were washed by using the electrolyte-free Percoll gradient and then preserved in electrolyte-free solution at 4 degrees C for a week, The preserved sperm was incubated and analyzed after the addition of electrolyte solutions under acid or alkaline condition, The sperm were continuously preserved for a day at room temperature and analyzed, (Result) The sperm was by the addition of 35∼135mM Na+ or 5∼135mM K+ in acid solutions. Under the alkaline conditions, sperm were reactivated without Na+ or K+. However, the addition of 135mM Na+ or K+ significantly decreased in sperm motilities. The some sperm in the solution containing low concentration of Na+ or K+ ions maintained their motilities for a day at room temperature. However, all sperm lost their motilities in the 135mM Na+ or K- solutions, (Conclusion) The high concentration of Na+ or K+ ions had detrimental effects on motilities of sperm following the preservation in electrolyte-free solution.

DOI： 10.5980/jpnjurol1989.93.440

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.93.280_1

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.93.206_2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING ASIA  

Background: Future fertility is a major concern for cancer patients who undergo intensive chemotherapy. There has been controversy about whether hormonal treatments may have protective effects against the severe spermatogenic damage caused by chemotherapy or irradiation. Recently, it has been proposed that gonadotrophin-releasing hormone (GnRH) analogs administered after testicular damage stimulate the recovery of spermatogenesis. In this study, we have investigated the effects of GnRH agonist, leuprorelin, on the damage to spermatogenesis induced by busulfan.
Methods: Fisher rats were treated with busulfan, 25 mg/kg, intraperitoneally. The effects of subcutaneous injections of leuprorelin before or after treatment were evaluated histologically 18 weeks later.
Results: The percentage of 'recovered' seminiferous tubules was 27.7 +/- 12.6% in control rats without leuprorelin and 26.9 +/- 10.2% in rats with leuprorelin injected 4 weeks before busulfan. Rats in both groups showed poor recovery of spermatogenesis with an increase of intratesticular fluid. However. rats treated with leuprorelin three times (4 weeks apart) after busulfan showed an improvement of up to 56.5 +/- 12.0% (P &lt; 0.05). A focal but massive necrotic lesion in the testis was observed only in this group of rats.
Conclusions: The results demonstrated that leuprorelin administered after chemical testicular damage enhanced the recovery of spermatogenesis. At the same time, a possible significant side-effect of leuprorelin was noted.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.92.216_2

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：MEDIMOND S R L  

The effect of Lycopene, one of cartenoids with strong anti-oxidative capacity, on Reactive Oxigen Species (ROS) generation in unprocessed semen was investigated. After oral administration of Lycopene 35 mg daily for 3 months to 10 male infertile patients with or without excess ROS in semen, sperm parameters and ROS levels were assesed. In all 5 patients with ROS positive semen, ROS levels in semen decreased. However, no improvement in sperm density and motility was recognized and only one pregnancy was reported from 1 out of 10 patients (10%).

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.91.320_1

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DOI： 10.5980/jpnjurol.91.364_4

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DOI： 10.5980/jpnjurol.91.366_3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL WISSENSCHAFTS-VERLAG GMBH  

It has previously been reported that human spermatozoa preserved in an electrolyte-free solution can survive for several weeks at 4 degrees C. However, the motility of spermatozoa after preservation cannot be restored when incubated at 37 degrees C, unless reactivated by extracellular alkalisation. Under weak acidic conditions, the reactivation is induced by greater than or equal to 10 mmol 1(-1) Na+ and inhibited by a Na+-H+ antiporter inhibitor. The addition of greater than or equal to 0.1 mmol l(-1) K+ also induces the reactivation. In the present study, the reactivation was induced by greater than or equal to 0.1 mmol l(-1) Rb+ or greater than or equal to 1mmol l(-1) Cs+ at an acidic pH. The maximum motility rate with K+, Rb+ or Cs+ was obtained at 10-20 mmol l(-1) and inhibited by 10(-5)-10(-2) mol l(-1) ouabain in a dose-dependent manner, while ouabain had no effect on the Na+ induced reactivation. The addition of K+ further increased sperm motility reactivated by Na+, which was also inhibited by ouabain. The addition of Ca2+ did not induce the reactivation or increase sperm motility reactivated by Na+ or K+. It was concluded that activation of the ouabain-sensitive Na+-K+ -ATPase and Na+-H+ exchange mechanism has an important role in sperm motility.

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Language：Japanese   Publisher：The Japanese Urological Association  

(Background) Radical cystectomy was usually performed for the patient with advanced bladder cancer. The choice of surgical procedure whether bladder preservaed therapy or radical cystecotmy has sometime plagued us in bladder cancer treatment. Because we don't have clear guideline for the treatment of locally advanced bladder cancer (T2-T3a N0M0). We devised a radical treatment for the patients with locally advanced bladder cancer without radical cystectomy.<br>(Patients and Methods) We performed re-TUR treatment after 3 weeks of initial TUR for 13 patients with grade 2 and locally advanced bladder cancer diagnosed with pelvic CT scan, transurethral ultrasonography or bimanual examination under the anesthesia.<br>(Results) We could successfully preserve all cases of bladder with the use of this devised TUR (periods 9-45 months median 22 months). This method has significantly reduced the cystectomy rate in such locally advanced cases compared with the cystectomy rate prior to 1993 (p<0.001).<br>(Conclusion) This method has significance on treatment for locally advanced papillary bladder cancer as bladder preserving therapy with careful observation.

DOI： 10.5980/jpnjurol1989.89.604

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Other Link： http://search.jamas.or.jp/link/ui/1998237166

Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER SOC REPRODUCTIVE MEDICINE  

Objective: To determine the safely and efficacy of the introduction of a low-electrolyte solution into the bladder before masturbation for sperm recovery in patients with retrograde ejaculation.
Design: Two case reports.
Setting: Assisted reproduction practice at a university hospital.
Patient(s): Two men with retrograde ejaculation.
Intervention(s): A 0.32-mol/L glucose solution or Ham's modified F-10 medium (GIBCO, Grand Island, NY) with 10% serum was introduced into the urinary bladder before masturbation. The retrieved sperm were used for IUL.
Main Outcome Measure(s): The motility of retrieved sperm, achievement of pregnancy, and outcome of pregnancy.
Result(s): In patient 1, the motility rate of sperm retrieved from the bladder after the introduction of Ham's modified F-10 medium was higher than that after the introduction of a glucose solution. The patient's wife did not become pregnant during 10 IUI cycles after treatment with Ham's modified F-IO medium. However, she became pregnant during the first IUI cycle after treatment with a glucose solution and was delivered of healthy twin infants. The wife of patient 2 also became pregnant during the first IUI cycle after treatment with a glucose solution and was delivered of a healthy female infant.
Conclusion(s): The introduction of a glucose solution appears to be a safe and simple method for sperm recovery in patients with retrograde ejaculation. (C)1998 by American Society for Reproductive Medicine.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Clinical outcome of bladder preserving therapy for superficial high-grade bladder cancers (pTa-pT1b, G3) was retrospectively studied. Twenty-six patients initially received bladder preserving therapy ('preserved' group), while 19 underwent radical cystectomy as the initial treatment ('cystectomized' group). Tumor recurrence was accompanied by a progression in the tumor grade in 9 patients with low-grade tumors ('grade-up' group). The 5-year survival rate was 87% and 100% in the preserved and cystectomized groups, respectively, with no significant difference. However, the grade-up group had a significantly worse rate of 57%. Failure in bladder preserving therapy was unrelated to the size or number of tumors. Our findings suggest that bladder preserving therapy is a reasonable treatment option for superficial high-grade tumors although a careful followup is mandatory. On the other hand, radical cystectomy should be considered for recurrent, grade-up G3 tumors.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We reported a case of ureteral polyp in a 12-year-old boy whose chief complaint was asymptomatic gross hematuria. An excretory urogram revealed severe right hydronephrosis with a filling defect of the upper ureter. Our diagnosis was right hydronephrosis due to the ureteral polyp. A partial ureterectomy with an end-to-end anastomosis was performed. A polyp was found in the excised ureter and the histological diagnosis was a fibroepithelial polyp. Six months after the operation, the right hydronephrosis showed remission.

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.87.453_2

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DOI： 10.3862/jcoloproctology.45.7_1024

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞人工知能(AI)は人のような知的な情報処理を実現するソフトウェアやプログラムであり,すでに医療の分野にも応用され始めている。われわれは顕微授精(ICSI)の精子選別におけるAIの応用が培養士の業務負担軽減につながると考え,精子選別支援システムの開発を行っている。AIによる精子認識は偽陽性率が高いなどの課題はあるもののスピーディーに行うことができており,現在は良好精子を選別するためのデータ蓄積・訓練を行っている。本システム開発が培養士の精子同定作業をサポートできる可能性は十分あると考えられ,今後さらに精度を高めて,よりよいシステムの開発を目指していきたい。

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：ELSEVIER DOYMA SL  

DOI： 10.1016/j.androl.2017.09.001

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Language：Japanese   Publisher：医学図書出版(株)  

症例は31歳男性。2年間の不妊および精液量の減少を主訴に当科受診。血液検査でLH、FSH、teststeroneがいずれも低値であり、Male hypognadotropichypogonadism(MHH)が疑われた。LH-RH負荷試験でLH、FSHともに低反応であり、MHHと診断となった。精査目的の頭部MRIでトルコ鞍内に腫瘍を認め、脳神経外科に紹介経蝶形骨洞手術を施行され、Rathke嚢胞の診断となった。第10病日に経過良好にて退院となった。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ELSEVIER SCIENCE INC  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2016153315

Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：医学図書出版(株)  

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J-GLOBAL

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

当院・関連施設を受診したムンプス精巣炎罹患後の造精機能障害7例について検討した。精巣容積については1例で片側精巣の萎縮をきたしていたものの、他の精巣は正常大であった。精液所見では両側例3例のうち無精子症は1例で、残る2例は乏精子症であった。片側例4例では、3例が高度乏精子症、1例が軽度の乏精子症であった。1例を除き6例は精液検査の測定が精巣炎罹患より6ヵ月以内と比較的急性期であり、ライディッヒ細胞機能低下を伴う造精機能障害がみられたが、その後の精液検査では片側例では全例、両側例では2例で精子濃度の改善を、また片側例3例、両側例2例で運動率の改善を認めた。妊娠成立の転帰が判明したものは2例(28.6%)で、うち1例は配偶者が自然妊娠し、他の1例はビタミンB12製剤の内服を継続し、体外受精にて配偶者が妊娠に至った。

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：金原出版(株)  

不妊を主訴に精液検査を行った549名1329検体を対象に、ルミノールによる化学発光法を用いてROSを定量的に測定し、各種精液検査パラメータとの相関について検討した。その結果、ROS陽性検体は481検体(36.2%)であった。ROS陽性群は陰性群と比べ、有意に運動率および頭部振幅の低下を認めた。さらにROS値と有意な負の相関を認めた精液検査パラメータは、精子濃度、運動率、曲線速度、頭部振幅であった。

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014393480

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会  

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例は46歳男性で、1年間の不妊を主訴に、婦人科にて乏精子症・精子無力症を指摘され、当科紹介となった。初診時の精液所見および血中プロラクチン濃度検査より、原因としてスルピリドによる薬剤性高プロラクチン血症が考えられたため、同薬剤を内服中止とした。内服中止2ヵ月後には精液所見の改善を認め、その後、配偶者は自然妊娠するに至った。

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：MARY ANN LIEBERT INC  

Web of Science

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